STATE OF MISSOURIDEPARTMENT OF HEALTH AND SENIOR SERVICES (Department)REQUEST FOR APPLICATION (RFA)

RFA NO.: 2027 PROCUREMENT OFFICER: Janett WalkerTITLE: Customized Caregiver Training & Relief Program PHONE NO.: (573) 751-6032ISSUE DATE: May 14, 2020 E-MAIL: Janett.Walker@health.mo.gov

RETURN APPLICATION NO LATER THAN: June 16, 2020 AT 3:00 PM CENTRAL TIME

MAILING INSTRUCTIONS: Print or type RFA Number and Return Due Date on the lower left hand corner of the envelope or package. Sealed applications must be returned to 920 Wildwood Dr., Jefferson City, MO 65109 by the return date and time.

RETURN APPLICATION TO:(U.S. Mail) (Courier Service)Department of Health and Senior Services or Department of Health and Senior ServicesProcurement Unit Procurement UnitP.O. Box 570 920 Wildwood Dr.Jefferson City, MO 65102-0570 Jefferson City, MO 65109

CONTRACT PERIOD: Date of Award through May 31, 2021

DELIVER SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING ADDRESS:

Missouri Department of Health and Senior ServicesDivision of Senior and Disability Services, Bureau of Senior Programs

PO BOX 570, Jefferson City, MO 65102

The Applicant hereby declares understanding, agreement and certification of compliance to provide the items and/or services, at the prices quoted, in accordance with all requirements and specifications contained herein and the Terms and Conditions (Revised 1/26/12). The Applicant further agrees that the language of this RFA shall govern in the event of a conflict with his/her application. The Applicant further agrees that upon receipt of an authorized purchase order from the Department of Health and Senior Services (Department/state agency) or when a Notice of Award is signed and issued by an authorized official of the Department, a binding contract shall exist between the Applicant and the Department.

SIGNATURE REQUIRED

VENDOR NAME

     

FEDERAL TAX ID NUMBER/MissouriBUYS SYSTEM ID

     DOING BUSINESS AS (DBA) NAME

     MAILING ADDRESS

     CITY, STATE, ZIP CODE

     

CONTACT PERSON

     

EMAIL ADDRESS

     PHONE NUMBER

     

FAX NUMBER

     VENDOR TAX FILING TYPE WITH IRS (CHECK ONE)

___ Corporation ___ Individual ___ State/Local Government ___ Partnership ___ Sole Proprietor ___IRS Tax-ExemptAUTHORIZED SIGNATURE DATE

     

RFA 2027

1. INTRODUCTION

1.1 This document constitutes a request for competitive, sealed applications for the provision of: 1) customized caregiver training and 2) respite and related services reimbursement relief for caregivers. These services are intended to postpone institutionalization of persons 60 years or older with Alzheimer’s disease or related dementias as set forth herein. The Missouri Department of Health and Senior Services, Division of Senior and Disability Services/Bureau of Senior Programs provides the oversight for this Request for Application (RFA).

1.2 Applicant means the person or organization who responds to the RFA by submitting an application with prices to provide services as required in the RFA document.

1.3 Contractor means an Applicant (either a person or organization) who is selected for a contract as a result of the RFA and who enters into a contract.

1.4 Shall or must identify components, deliverables, or actions that are mandatory. Failure to comply with this RFA will result in an application being considered non-responsive.

2. ORGANIZATION

2.1 This document, referred to as a RFA, is divided into the following parts:

a) Application and Contractual Requirements b) Attachments A - F c) Exhibits 1 - 11 (Items which may need to be returned with the application)d) Terms and Conditions

3. COMMUNICATION REGARDING THE RFA

3.1 It is the Applicant’s responsibility to ask questions, request changes or clarifications, or otherwise advise the Department if the Applicant believes that any language, specifications, or requirements are: (1) ambiguous, (2) contradictory or arbitrary, or both, (3) violate any state or federal law or regulation, (4) restrict or limit the requirements to a single source, or (5) restrict or limit the Applicant’s ability to submit an application.

3.1.1 Except as may be otherwise stated herein, the Applicant and the Applicant’s agents (including subcontractors, employees, consultants, or anyone else acting on their behalf) must direct all of their questions or comments regarding the RFA, the application process, the evaluation, etc., to the procurement officer of record indicated on the first page of this RFA.  Inappropriate contacts to other personnel are grounds for exclusion from being considered for an award. Applicants and their agents who have questions regarding this RFA should contact the procurement officer.

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a. The Applicant may contact the Office of Administration, Office of Equal Opportunity (OEO) regarding Minority Owned Business Enterprise (MBE)/Woman Owned Business Enterprise (WBE) certification or subcontracting with MBE/WBE companies.

3.1.2 The Applicant should submit all questions and issues at least ten (10) working days prior to the due date of the application.  If not received prior to ten (10) working days before the application due date, the Department may not be able to fully research and consider the respective questions or issues before the RFA due date.  Questions and issues relating to the RFA, including questions related to the competitive application process, must be directed to the procurement officer.  It is preferred that questions be e-mailed to the procurement officer at Janett.Walker@health.mo.gov.

3.1.3 The Department will attempt to ensure that an Applicant receives an adequate and prompt response to questions, if applicable.  Upon the Department’s consideration of questions and issues, if the Department determines that changes are necessary, the resulting changes will be included in a subsequently issued RFA amendment(s); absence of such response indicates that the questions and issues were considered but deemed unnecessary for RFA amendment as the questions and issues did not provide further clarity to the RFA.  All Applicants will be advised of any change to the RFA’s language, specifications, or requirements by a formal amendment to the RFA. 

3.1.4 The official RFA can be viewed at the Department Internet site, http://health.mo.gov/information/publicnotices/invitations/index.php.

a. The Department reserves the right to officially amend or cancel a RFA after issuance. It shall be the sole responsibility of the applicant to monitor the website daily.

3.1.5 The Applicant is advised that the only official position of the Department is the position that is stated in writing and issued by the Department as a RFA and any amendments thereto. No other means of communication, whether oral or written, shall be construed as a formal or official response or statement on behalf of the Department.

4. GENERAL CONTRACTUAL REQUIREMENTS

4.1 To the extent that this contract involves the use, in whole or in part, of federal funds, the signature of the Contractor’s authorized representative on the first page of this document indicates compliance with the Certifications contained in Attachment A, which is attached hereto and is incorporated by reference as if fully set forth herein.

4.2 The Department has determined this contract is subrecipient in nature as defined in 2 CFR § 200.330. To the extent that this contract involves the use, in whole or in part, of federal funds, the Contractor shall comply with the special conditions contained in Attachment B, which is attached hereto and is incorporated by reference as if fully set forth herein.

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4.3 After the award, unless otherwise stated in this contract, the Contractor shall use the below information for any correspondence regarding this contract:

Program Name: Customized Caregiver Training and Relief ProgramProgram Contact: Molly McGrathAddress: 912 Wildwood Dr., P.O. Box 570, Jefferson City MO 65102Phone: 573-526-4389Email: molly.mcgrath@health.mo.gov

5. DEFINITIONS

5.1 Whenever the following terms and acronyms appear in the RFA document or any amendment thereto, the definition or meaning described below shall apply.

5.1.1 Alzheimer’s disease--a degenerative brain disease of unknown cause that is the most common form of dementia; usually starts in late middle age or in old age; results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood; and is marked histologically by the degeneration of brain neurons especially in the cerebral cortex and by the presence of neurofibrillary tangles and plaques containing beta-amyloid.

5.1.2 Dementia—a usually progressive condition (such as Alzheimer’s disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior).

5.1.3 Caregiver—a person who resides in the home of and provides direct care to a person with Alzheimer’s disease or related dementias (residing in the home can be waived for Track 1 but is required for Track 2).

5.1.4 In-Home Services—Services provided inside the home of the person affected by Alzheimer’s disease or related dementias.

5.1.5 Caregiver Training (Track 1 Program)—Training provided to the caregiver/caregivers of a person affected by Alzheimer’s disease or related dementias. The training should reduce caregiver stress, improve communication with the person suffering from memory loss and make the home safer for individuals with Alzheimer’s disease or related dementias.

5.1.6 Caregiver Relief (Track 2 Program)—Reimbursement provided to a caregiver of someone with Alzheimer’s disease or related dementias to cover respite and related services. Respite can be provided in the home or at a facility (short-term stay). Related services include: assessment and care coordination, adult day care, safety and supportive programs, education programs, and counseling services.

6. BACKGROUND INFORMATION

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6.1 Alzheimer’s disease is the most common cause of dementia as it accounts for 60 to 80 percent of dementia cases. Alzheimer’s disease is not a normal part of aging and worsens over time. The greatest known risk factor is increasing age and the majority of people with Alzheimer’s disease are 65 and older. Alzheimer’s disease may begin with mild memory loss in the early stages but will eventually lead to individuals losing the ability to carry on a conversation and respond to their environment in the late stages. Alzheimer’s disease is the sixth leading cause of death in the United States. Although Alzheimer’s disease has no current cure, treatments for symptoms are available. Current treatments cannot stop Alzheimer’s disease from progressing, but can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s disease and their caregivers.

6.1.1 It is estimated that there are at least 110,000 citizens with Alzheimer’s disease within the State of Missouri. Furthermore, the Alzheimer’s disease population continues to grow in the state. The number of Missourians with the disease is expected to increase to 130,000 by 2025.

6.1.2 The impact of Alzheimer’s disease reaches beyond the person with the disease to include spouses, parents, children, grandchildren and other caregivers who are responsible financially, physically, and emotionally for providing or arranging care. In 2019, the direct costs of caring for those with Alzheimer’s disease will total an estimated $290 billion. In Missouri, there are an estimated 317,000 family caregivers for persons with Alzheimer’s disease or related dementias. Alzheimer’s disease takes a devastating toll on caregivers. Twice as many caregivers of those with dementia, when compared with caregivers of people without dementia, indicate substantial emotional, financial and physical difficulties.

6.1.3 The Department of Health and Senior Services’ Alzheimer’s Service Program was initiated in 1987 with funding appropriated by the State of Missouri to assist persons with Alzheimer’s disease or related dementias and their families by providing respite and other related services to caregivers in order to postpone institutionalization. The Customized In-Home Caregiver Training Program was initiated in 2007 to provide personalized training, that includes care consultations in the home of the caregiver, to reduce caregiver stress, improve communication, and make the home safer for the person diagnosed with Alzheimer’s disease or related dementias.

6.1.4 Beginning July 1, 2020, these two funding opportunities will be combined to better serve Missourians. This new opportunity, Customized Caregiver Training and Relief Program, will be divided into two tracks. Track 1 will focus on caregiver training while Track 2 will focus on caregiver relief.

6.2 The Department shall receive funding, not to exceed $97,000 for Track 1 and $436,500 for Track 2, for this RFA. The funding for each track will be allocated equally across four service areas. The Department anticipates to award per service area.

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6.2.1 Service Area: Region 1: Counties of Andrew, Atchison, Benton, Buchanan, Caldwell, Carroll, Cass, Chariton, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, and Worth.

6.2.2 Service Area: Region 2: Counties of Adair, Audrain, Boone, Callaway, Camden, Clark, Cole, Cooper, Crawford, Franklin, Gasconade, Howard, Knox, Laclede, Lewis, Lincoln, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Phelps, Pike, Pulaski, Putnam, Ralls, Randolph, Schuyler, Scotland, Shelby, St. Charles, Sullivan, and Warren.

6.2.3 Service Area: Region 3: Counties of Barry, Barton, Bates, Cedar, Christian, Dade, Dallas, Douglas, Green Henry, Hickory, Howell, Jasper, Lawrence, McDonald, Newton, Oregon, Ozark, Polk, Shannon, St. Clair, Stone, Taney, Texas, Vernon, Webster, and Wright.

6.2.4 Service Area: Region 4: Counties of Bollinger, Butler, Cape Girardeau, Carter, Dent, Dunklin, Iron, Jefferson, Madison, Mississippi, New Madrid, Pemiscot, Perry, Reynolds, Ripley, Scott, St. Francois, St. Louis City, St. Louis County, Ste. Genevieve, Stoddard, Washington, and Wayne.

6.3 The Department has attempted to provide accurate and up-to-date information in this RFA; however, the Department does not warrant or represent that the background information provided herein reflects all relationships or existing conditions related to this RFA.

7. PURPOSE AND GOAL

7.1 To provide customized caregiver training or respite and related services reimbursement relief for caregivers to postpone institutionalization of persons 60 years or older with Alzheimer’s disease or related dementias as set forth herein in order to reduce the caregivers’ burden/stress, improve communication, enhance quality of life, and make the home safer for individuals diagnosed with Alzheimer’s disease or related dementias.

8. CONTRACTUAL REQUIREMENTS

8.1 The Contractor shall provide a Caregiver Training Program (Track 1 Program) and a Caregiver Relief Program (Track 2 Program) for the Contractor’s awarded area(s). The Contractor’s Track 1 Program and Track 2 Program shall strive to meet the following program goals:

8.1.1 Increase awareness and participation in Alzheimer’s disease services available through the program;

8.1.2 Increase understanding of Alzheimer’s disease and options available for care;

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8.1.3 Increase caregivers ability to cope with persons with Alzheimer’s disease or related dementias;

8.1.4 Improve the safety and well-being of persons with Alzheimer’s disease or related dementias;

8.1.5 Improve the well-being and reduce the stress of family caregivers;

8.1.6 Increase awareness and access to assistive services in the community; and

8.1.7 Increase the proportion of long-term care provided in homes for persons with Alzheimer’s disease while reducing the number of persons with Alzheimer’s disease who are prematurely or unnecessarily institutionalized.

8.2 The Contractor shall not allow a participant to enroll in both Contractor’s Track Programs within the same contract year.

8.3 The Contractor shall report to the Adult Abuse and Neglect Hotline (1-800-392-0210) any instances of abuse, neglect, bullying or exploitation of a vulnerable adult between the ages of 18-59 or an individual over the age of 60 pursuant to the laws of the state of Missouri. The Contractor shall report to the Child Abuse/Neglect Hotline (1-800-392-3738) any instances of child abuse or neglect pursuant to the laws of the state of Missouri.

8.4 Unless otherwise specified, the Contractor shall furnish all material, labor, facilities, equipment, and supplies necessary to perform the services required.

8.5 The Contractor shall perform all services in accordance with the provisions and requirements stated herein and to the sole satisfaction of the Department.

9. TRACK 1 PROGRAM DELIVERABLES

9.1 The Contractor shall provide Caregiver Training for the Contractor’s Track 1 Program to the service area(s) awarded. The Caregiver Training shall include:

9.1.1 An in-home assessment of the person with Alzheimer’s disease or related dementias and his/her unmet needs that will be utilized to develop customized training for the caregiver to help meet the identified needs of the individual with Alzheimer’s disease or related dementias and reduce stress on the caregiver.

9.1.2 Care plan development to help meet the unmet needs of the individual with Alzheimer’s disease or related dementias and reduce stress on the caregiver.

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9.1.3 Training materials and resources for caregivers to help them modify daily activities of the individual diagnosed with Alzheimer’s disease or related dementias to promote independence.

9.1.4 Follow-up calls/visits to ensure the care plan is addressing the needs of the individual with Alzheimer’s disease or related dementias and their caregiver and to provide additional resources as necessary.

9.1.5 Where necessary, Contractor provided assistive safety devices to help with activities of daily living and/or increase the safety and well-being of a person with Alzheimer’s disease or related dementias while remaining in their home.

9.1.6 Referrals to other community supports and resources as necessary to help meet the needs of the individual with Alzheimer’s disease or related dementias.

9.2 The Contractor shall provide a minimum of twenty-five (25) Caregiver Trainings per awarded service area. The trainings will be provided in those counties determined by the Contractor to have the greatest need for the services. The trainings should not be concentrated in large metropolitan areas (urbanized area of 50,000 or more inhabitants). Participation in the Contractor’s Track 1 Program will be limited to one year. The Department may allow exceptions on a case-by-case basis if a determination is made that there is great need for additional services.

9.3 The Contractor’s program must be fully operational within sixty (60) days of the effective date of the contract.

9.4 The Contractor shall make the program available to qualified persons in all counties within the awarded service area(s). Service Areas, estimated Alzheimer’s disease population per county, and service area map are shown in Attachment C, which is attached hereto and is incorporated by reference as if fully set forth herein.

9.5 The Contractor shall survey program participants annually to determine their satisfaction with the program and to gauge their opinions on the goals outlined in the Contractor’s program goals.

10. TRACK 2 PROGRAM DELIVERABLES

10.1 The Contractor shall provide Caregiver Relief for the Contractor’s Track 2 Program to the service area(s) awarded. The Caregiver Relief shall include:

10.1.1 Assessment and Care Coordination - an initial assessment and reassessment(s) of the individual with Alzheimer’s disease or related dementias and needs of the family. Additionally, the Contractor shall provide care options counseling to aid in planning the future care of their loved ones, assistance in developing an individualized plan to meet the needs of the family, and information and referrals for family support services offered by the Contractor’s Track 2 Program and through community organizations.

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10.1.2 Reimbursement for one or more of the following services to persons with Alzheimer’s disease or related dementias and their families.

a. Respite Assistance - in-home or facility-based care to provide caregivers a temporary rest from caregiving, while the person with Alzheimer’s disease or related dementias continues to receive care in a safe environment. Care can be provided professionally or by another family member/family friend.

b. Adult Day Care - supervision, meaningful social activities, nutrition, and other care to persons with Alzheimer’s disease or related dementias in a group setting outside of the home for periods of two (2) to twenty-four (24) hours per day.

c. Safety and Supportive Programs - relief to family caregivers through assistive services (e.g. legal assistance, transportation, and therapeutic activities) and products (e.g. mobility devices, medication related to the Alzheimer’s disease or related dementias, nutritional shakes and incontinence supplies).

d. Education Programs - opportunities to persons with Alzheimer’s disease or related dementias, the caregiver, and family members to participate in educational classes and/or furnish information on the nature of the disease and its progression, disease management, treatments and medications, falls prevention and safety considerations, nutrition and health promotion, caregiver guidance and supports, emerging research advances, and the array of community-based services.

e. Counseling Services - individual and/or group therapeutic counseling for persons with Alzheimer’s disease or related dementias and/or caregiver/family members.

f. Other - If the Contractor provides other services than those listed above, the Contractor shall obtain Department approval prior to performing other services.

10.2 The Contractor shall provide a minimum of one hundred thirty-five (135) Caregiver Relief reimbursements per awarded service area. Caregiver Relief will be provided in those counties determined by the Contractor to have the greatest need for the services. Caregiver Relief should not be concentrated in large metropolitan areas (urbanized area of 50,000 or more inhabitants). To ensure a maximum number of caregivers have the opportunity to participate, the reimbursements for Track 2 will be capped at $700 per year per person with Alzheimer’s disease or related dementias. Participation in the Contractor’s Track 2 Program will be limited to two years. The Department may allow exceptions on a case-by-case basis if a determination is made that there is great need for additional services.

10.2.1 Participants should begin to utilize the Track 2 Program funds within forty-five (45) days of program acceptance or funds may be reallocated to a new participant.

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10.3 The Contractor’s program must be fully operational within sixty (60) days of the effective date of the contract.

10.4 The Contractor shall make the program available to qualified persons in all counties within the awarded service area(s). Service Areas, estimated Alzheimer’s disease population per county, and service area map are shown in Attachment C.

10.5 The Contractor shall survey program participants annually to determine their satisfaction with the program and to gauge their opinions on the goals outlined in the Contractor’s program goals.

10.6 The Contractor may allot a portion of the award from the Contractor’s Track 2 Program to Outreach - Outreach shall promote the availability of services to the public with targeted efforts to reach and increase service to low income, minority, limited English Proficiency and rural populations.

11. REPORTS

11.1 The Contractor shall submit a Monthly Data Report along with the monthly invoice.

11.1.1 The Track 1 Program Monthly Data Report shall include the counties in which the services were provided; the number of assessments completed; the number of care plans developed; the number, type and cost of safety products provided; the number of trainings completed; and information regarding follow-up visits. Please see Attachment D, which is attached hereto and is incorporated by reference as if fully set forth herein, for service unit definitions.

11.1.2 The Track 2 Program Monthly Data Report shall include the counties in which the services were provided; the number of unduplicated persons that received services; and the number of units of service delivered in each allowable category. Please see Attachment D for service unit definitions.

11.2 The Contractor shall submit a Subrecipient Annual Financial Report (Attachment E, which is attached hereto and is incorporated by reference as if fully set forth herein). For a contract period of twelve months or less, the Contractor shall submit this report at the time the final invoice is due. For a contract period over twelve months, the Contractor shall submit this report annually and at the time the final invoice is due.

11.3 The Contractor shall submit a final report no later than thirty (30) days after the conclusion of the original contract period and after any subsequent contract renewal periods. The Contractor shall provide an annual comprehensive programmatic evaluation of the services provided during the contract period. At a minimum, the Contractor shall provide the following information within the programmatic evaluation:

11.3.1 A brief description of accomplishments, collaborations, outcomes, and barriers.

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11.3.2 Quantifiable outcomes that demonstrate the impact of services provided by the program to: a. Increase awareness and participation in Alzheimer’s disease services available

through the program; b. Increase understanding of Alzheimer’s disease and options available for care; c. Increase caregivers ability to cope with person with Alzheimer’s disease or

related dementias; d. Improve the safety and well-being of persons with Alzheimer’s disease or related

dementias; e. Improve well-being and reduce the stress of family caregivers; f. Increase awareness and access to assistive services in the community; and g. Increase the proportion of long-term care provided in homes and communities for

persons with Alzheimer’s disease or related dementias and reduce the number of persons with Alzheimer’s disease or related dementias who are prematurely or unnecessarily institutionalized.

11.3.3 If utilizing an online training system, the total number of participants that accessed the training and the number of participants that completed the training.

11.3.4 The total number of unduplicated persons that received the services through the contract reported by county and zip code.

11.3.5 The total number of units of service delivered by category (see Attachment D for service unit definitions).

11.3.6 The total number of persons that received services in each allowable category of service.

11.3.7 The number of family caregivers and persons with Alzheimer’s disease or related dementias in Missouri who requested services but were not served or served through alternate program funding due to lack of resources from this program.

11.3.8 The results from the annual participant survey.

12. BUDGET AND ALLOWABLE COSTS

12.1 The Department will reimburse the Contractor for an amount not to exceed the total contract amount for only the allowable costs in the budget categories stated on the Pricing Page Analysis, Exhibit 1, which is attached hereto and is incorporated by reference as if fully set forth herein.

12.2 The Department reserves the right to reallocate or reduce contract funds at any time during the contract period due to underutilization of contract funds or changes in the availability of program funds. The Department will provide the Contractor with thirty (30) days prior written notification of any reallocation.

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12.3 If the Contractor identifies specific needs within the Scope of Work, the Contractor may rebudget up to 10% of the total budget between object class categories of the budget without obtaining prior written approval of the Department. The Contractor and the Department must agree to a written contract amendment for any other rebudgeting.

12.4 Indirect costs

12.4.1 Indirect costs are those associated with the management and oversight of any organization’s activities and are a result of all activities of the Contractor. Indirect costs may include utilities, rent, administrative salaries, financial staff salaries, and building maintenance.

12.4.2 The Contractor shall not bill the Department for indirect costs that exceed 10% of the modified total direct costs as defined in 2 CFR § 200.68.

a. Modified Total Direct Cost Method (MTDC) means all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $25,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $25,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs, and with the approval of the cognizant agency for indirect costs.

12.4.3 It is the Contractor’s responsibility to correctly apply the indirect rate to the applicable direct costs claimed on each invoice.

12.5 The Contractor shall maintain records for salary and wages charged under the contract that accurately reflect the work performed.

12.6 The Contractor shall invoice and be reimbursed for actual and reasonable travel expenses either at the Contiguous US Per Diem Rates (CONUS) or the travel reimbursement rates set by the Contractor’s internal policy, whichever is lower.

12.6.1 The Contractor must have the prior written approval of the Department for any travel related expenses which may exceed the CONUS rates.

12.6.2 The Contiguous US Per Diem Rates (CONUS) can be found by clicking on the link for “Per Diem Rates” at the following Internet address: http://www.gsa.gov.

12.7 The Contractor shall follow competitive procurement practices.

12.8 The Department shall in all cases be utilized as “payor of last resort” which means that payment under this contract may be available only after the Contractor has demonstrated that all other payment sources, including but not limited to insurance

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coverage and/or government assistance programs, have been exhausted. Documentation of such shall be maintained in client files to be available for contract monitoring purposes.

13. INVOICING AND PAYMENT

13.1 If the Contractor has not already submitted a properly completed Vendor Input/Automated Clearing House Electronic Funds Transfer (ACH-EFT) Application, the Contractor shall complete and submit this Application. The Department will make payments electronically to the Contractor’s bank account. The Department may delay payment until the Vendor Input/ACH-EFT Application is received from the Contractor and validated by the Department.

13.1.1 A copy of Vendor Input/ACH-EFT Application and completion instructions may be obtained from the Internet at: https://www.vendorservices.mo.gov/vendorservices/Portal/Default.aspx

13.1.2 The Contractor must fax the Vendor Input/ACH-EFT Application to: Office of Administration, Division of Accounting at 573-526-9813.

13.2 The Contractor shall invoice the Department on the Contractor’s original descriptive business invoice form. The Contractor shall use uniquely identifiable invoice numbers to distinguish an invoice from a previously submitted invoice.

13.3 The invoice number will be listed on the state’s EFT addendum record to enable the Contractor to properly apply state payments to invoices. The Contractor must comply with all other invoicing requirements stated in the RFA.

13.4 The Contractor shall submit invoices monthly. Invoices shall be due by the 15th day of the month following the month in which the Contractor provided services under the contract. The Contractor shall perform the services prior to invoicing the Department.

13.5 The Department will pay the Contractor monthly upon the receipt and approval of an invoice and report(s) prepared according to the terms of this contract.

13.6 The Contractor shall submit all invoices and reports to:

Missouri Department of Health and Senior ServicesDivision of Senior and Disability Services/Bureau of Senior ProgramsP.O. Box 570Jefferson City, MO 65102-0570Email: Molly.McGrath@health.mo.gov

13.7 The Contractor shall submit the final invoice by June 10 of the contract year. The Department shall have no obligation to pay any invoice submitted after the due date.

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13.8 If the Department denies a request by the Contractor for payment or reimbursement, the Department will provide the Contractor with written notice of the reason(s) for denial.

13.9 The Contractor agrees that any audit exception noted by governmental auditors shall not be paid by the Department and shall be the sole responsibility of the Contractor. However, the Contractor may contest any such exception and the Department will pay the Contractor all amounts which the Contractor may ultimately be held entitled to receive as a result of any such legal action.

13.10 Notwithstanding any other payment provision of this contract, if the Contractor fails to perform required work or services, fails to submit reports when due, or is indebted to the United States government, the Department may withhold payment or reject invoices under this contract.

13.11 If the Contractor is overpaid by the Department, the Contractor shall provide the Department (1) with a check made payable as instructed by the Department or (2) deduct the overpayment from an invoice as requested by the Department.

13.11.1 For payment by check, the Contractor shall issue a check made payable to “DHSS-DA-Fee Receipts” and mail the check to:

Missouri Department of Health and Senior ServicesDivision of Administration, Fee ReceiptsP.O. Box 570920 Wildwood DriveJefferson City, Missouri 65102-0570

13.12 If the Department used a federal grant to pay the Contractor, the Catalog of Federal Domestic Assistance (CFDA) number assigned to the grant and the dollar amount paid from the grant is available on the State of Missouri Vendor Services Portal under the Vendor Payment section at https://www.vendorservices.mo.gov/vendorservices/Portal/Default.aspx. The CFDA name is available at https://beta.sam.gov/.

13.13 Other than the payments and reimbursements specified above, no other payments or reimbursements shall be made to the Contractor.

14. CONTRACT

14.1 A binding contract shall consist of: (1) the RFA and any amendments thereto, (2) the Contractor’s response (application) to the RFA, (3) clarification of the application, if any, and (4) the Department’s acceptance of the response (application) by “notice of award”. All Exhibits and Attachments included in the RFA shall be incorporated into the contract by reference.

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14.1.1 The contract expresses the complete agreement of the parties and performance shall be governed solely by the specifications and requirements contained therein.

14.2 The original contract period shall be as stated on page 1 of the RFA. The contract shall not bind, nor purport to bind, the state for any contractual commitment in excess of the original contract period.

15. AMENDMENTS

15.1 Any changes to this contract shall be made only through execution of a written amendment signed and approved by an authorized signatory of each party.

16. RENEWALS

16.1 The parties may renew the agreement for two (2) additional one-year periods if mutually agreed to by both parties. Such renewal shall be accomplished in writing and must be signed by both parties.

16.1.1 If the option for renewal is exercised, the Contractor shall agree that the prices for the renewal period shall not exceed the maximum price for the applicable renewal period stated on the Pricing Page Analysis of the contract.

a. If renewal prices are not provided, then prices during renewal periods shall be the same as during the original contract period.

b. In addition, the Contractor shall understand and agree that renewal period price increases specified in the contract are not automatic. At the time of contract renewal, if the Department determines funding does not permit the specified renewal pricing increase or even a portion thereof, the renewal pricing shall remain the same as during the previous contract period. If such action is rejected by the Contractor, the contract may be terminated, and a new application process may be conducted. The Contractor shall also understand and agree the Department may determine funding limitations necessitate a decrease in the Contractor’s pricing for the renewal period(s). If such action is necessary and the Contractor rejects the decrease, the contract may be terminated, and a new application process may be conducted.

17. MONITORING

17.1 The Department reserves the right to monitor the Contractor during the contract period to ensure financial and contractual compliance.

17.2 If the Department deems a Contractor to be high-risk, the Department may impose special conditions or restrictions on the Contractor, including but not limited to the following: withholding authority to proceed to the next phase of the project until the Department receives evidence of acceptable performance within a given contract period; requiring additional, more detailed financial reports or other documentation;

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additional project monitoring; requiring the Contractor to obtain technical or management assistance; or establishing additional prior approvals from the Department. The Department may impose special conditions or restrictions at the time of the contract award or at any time after the contract award. The Department will provide written notification to the Contractor prior to the effective date of the high-risk status.

17.3 If the Department determines a Contractor to be high risk in response to a monitoring report, the Department may request the Contractor provide an audit performed in accordance with generally accepted auditing standards at the expense of the Contractor.

18. DOCUMENT RETENTION

18.1 The Contractor shall retain all books, records, and other documents relevant to this contract for a period of three (3) years after final payment or the completion of an audit, whichever is later, or as otherwise designated by the federal funding agency and stated in the contract.

18.2 The Contractor shall allow authorized representatives of the Department, State, and Federal Government to inspect these records upon request.

18.3 If the Contractor is subject to any litigation, claim, negotiation, audit or other action involving the records before the expiration of the three (3) year period, the Contractor shall retain the records until completion of the action and resolution of all issues which arise from it, or until the end of the regular three (3) year period, whichever is later.

18.4 If the Department is subject to any litigation, claim, negotiation, audit or other action involving the records, the Department will notify the Contractor in writing to extend the Contractor’s retention period.

18.5 The Department may recover any payment it has made to the Contractor if the Contractor fails to retain adequate documentation.

19. CONFIDENTIALITY

19.1 The Contractor shall safeguard Protected Personally Identifiable Information (PII) as defined in 2 CFR § 200.82. The Contractor agrees it will assume liability for all disclosures of Protected PII and breaches by the Contractor and/or the Contractor’s subcontractors and employees.

19.2 The Contractor shall comply with provisions of Attachment F, which is attached hereto and is incorporated by reference as if fully set forth herein, in regards to the Health Insurance Portability and Accountability Act of 1996, as amended.

20. LIABILITY

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20.1 The Contractor shall understand and agree that the State of Missouri cannot save and hold harmless and/or indemnify the Contractor or employees against any liability incurred or arising as a result of any activity of the Contractor or any activity of the Contractor's employees related to the Contractor's performance under the contract.

20.2 The relationship of the Contractor to the Department shall be that of an independent contractor. The Contractor shall have no authority to represent itself as an agent of the Department. Nothing in this contract is intended to, nor shall be construed in any manner as creating or establishing an agency relationship or the relationship of employer/employee between the parties. Therefore, the Contractor shall assume all legal and financial responsibility for taxes, FICA, employee fringe benefits, workers compensation, employee insurance, minimum wage requirements, overtime, or any other applicable employee related obligation or expense, and shall assume all costs, attorney fees, losses, judgments, and legal or equitable imposed remedies associated with the matters outlined in this paragraph in regards to the Contractor’s subcontractors, employees and agents. The Contractor shall have no authority to bind the Department for any obligation or expense not specifically stated in this contract. This provision is not intended to waive any claim of sovereign immunity to which a public entity would otherwise be entitled to under Missouri law.

20.3 The Contractor shall be responsible for all claims, actions, liability, and loss (including court costs and attorney’s fees) for any and all injury or damage (including death) occurring as a result of the Contractor’s performance or the performance of any subcontractor, involving any equipment used or service provided, under the terms and conditions of this contract or any subcontract, or any condition created thereby, or based upon any violation of any state or federal statute, ordinance, building code, or regulation by Contractor. However, the Contractor shall not be responsible for any injury or damage occurring as a result of any negligent act or omission committed by the Department, including its officers, employees, and assigns. This provision is not intended to waive any claim of sovereign immunity to which a public entity would otherwise be entitled to under Missouri law.

20.4 The Contractor must acquire and maintain adequate liability insurance in the form(s) and amount(s) sufficient to protect the State of Missouri, its agencies, its employees, its clients, and the general public against any such loss, damage and/or expense related to his/her performance under the contract. The insurance coverage shall include but not necessarily be limited to general liability and appropriate professional liability. The general and other non-professional liability insurance shall include an endorsement that adds the State of Missouri as an additional insured.

20.4.1 Written evidence of the insurance shall be provided by the Contractor to the Department prior to performance under the contract. The evidence of insurance shall include, but shall not necessarily be limited to: effective dates of coverage, limits of liability, insurer's name, policy number, endorsement for the non-professional liability insurance naming the State of Missouri as an additional insured, endorsement by representatives of the insurance company, etc. The contract number must be identified

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on the evidence of insurance coverage. Evidence of self-insurance coverage or of another alternative risk financing mechanism may be utilized provided that such coverage is verifiable and irrevocably reliable and the State of Missouri is protected as an additional insured.

20.4.2 In the event the insurance coverage is canceled, the Contractor must notify the Department within thirty (30) calendar days of the cancellation.

21. PUBLICATIONS, COPYRIGHTS, AND RIGHTS IN DATA AND REPORTS

21.1 If the Contractor issues any press releases mentioning contract activities, the Contractor shall reference in the release both the contract number and the Department. If the Contractor creates any publications, including audiovisual items, produced with contract funds, the Contractor shall give credit to both the contract and the Department in the publication. The Contractor shall obtain approval from the Department prior to the release of such press releases or publications.

21.1.1 Notwithstanding subparagraph 1 of this section, in the event the Contractor is a university and intends to create a scholarly publication using materials created for the Department under this project, the Contractor shall provide the Department with the opportunity to review and to provide comment on the proposed publication. At the Department’s request, Contractor will insert a disclaimer in any publication that says the publication does not necessarily reflect the views or opinions of the Department. Any such publication created by the Contractor shall contain acknowledgment of the Department’s sponsorship as required by 48 CFR § 52.227-14(c).

21.2 In accordance with the “Steven’s Amendment” in the Department of Labor, Health and Human Services, and Education and Related Agencies Appropriations Act, the Contractor shall not issue any statements, press release, request for proposals, application solicitations, and other documents describing projects or programs funded in whole or in part with Federal money unless it clearly states the following:

21.2.1 The percentage of the total costs of the program or project which will be financed with Federal money; and

21.2.2 The percentage of the total costs of the program or project which will be financed by nongovernmental sources.

21.3 If the Contractor develops any copyrighted material as a result of this contract, the Department shall have a royalty-free, nonexclusive and irrevocable right to publish or use, and to authorize others to use, the work for Department purposes or the purpose of the State of Missouri.

21.4 If the Contractor is a State University, the Department limits the requirements of number 10 of the Department’s Terms and Conditions to the extent permitted by law and without waiving sovereign immunity.

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22. AUTHORIZED PERSONNEL

22.1 The Contractor shall be responsible for assuring that all personnel are appropriately qualified and licensed or certified, as required by state, federal or local law, statute or regulation, respective to the services to be provided through this contract; and documentation of such licensure or certification shall be made available upon request.

22.2 The Contractor shall only utilize personnel authorized to work in the United States in accordance with applicable federal and state laws. This includes but is not limited to the Immigration Reform and Control Act of 1986 as codified at 8 U.S.C. § 1324a, the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) and Section 274A of the Immigration and Nationality Act. If the Contractor is found to be in violation of these requirements or the applicable laws of the state, federal and local laws and regulations, and if the State of Missouri has reasonable cause to believe that the Contractor has knowingly employed individuals who are not eligible to work in the United States, the state shall have the right to cancel the contract immediately without penalty or recourse and suspend or debar the Contractor from doing business with the state. The state may also withhold up to twenty-five percent of the total amount due to the Contractor. The Contractor agrees to fully cooperate with any audit or investigation from federal, state or local law enforcement agencies.

22.3 Affidavit of Work Authorization and Documentation - Pursuant to section 285.530, RSMo, if the Applicant/Contractor meets the section 285.525, RSMo definition of a “business entity” (http://www.moga.mo.gov/mostatutes/stathtml/28500005301.html?&me=285.530), the Applicant/Contractor must affirm the Applicant’s/Contractor’s enrollment and participation in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services requested herein. The Applicant/Contractor should complete applicable portions of Exhibit 2, Business Entity Certification, Enrollment Documentation, and Affidavit of Work Authorization. The applicable portions of Exhibit 2 must be submitted prior to an award of a contract.

22.4 If the Contractor meets the definition of a business entity as defined in section 285.525, RSMo pertaining to section 285.530, RSMo the Contractor shall maintain enrollment and participation in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the contracted services included herein. If the Contractor’s business status changes during the life of the contract to become a business entity as defined in section 285.525, RSMo pertaining to section 285.530, RSMo then the Contractor shall, prior to the performance of any services as a business entity under the contract:

22.4.1 Enroll and participate in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services required herein; AND

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22.4.2 Provide to the Missouri Department of Health and Senior Services the documentation required in the exhibit titled, Business Entity Certification, Enrollment Documentation, and Affidavit of Work Authorization affirming said company’s/individual’s enrollment and participation in the E-Verify federal work authorization program; AND

22.4.3 Submit to the Missouri Department of Health and Senior Services a completed, notarized Affidavit of Work Authorization provided in the exhibit titled, Business Entity Certification, Enrollment Documentation, and Affidavit of Work Authorization.

22.5 In accordance with subsection 2 of section 285.530 RSMo, the Contractor should renew their Affidavit of Work Authorization annually. A valid Affidavit of Work Authorization is necessary to award any new contracts.

23. TERMINATION

23.1 The Department, in its sole discretion, may terminate the obligations of each party under this contract, in whole or in part, effective immediately upon providing written notification to the Contractor if:

23.1.1 State and/or federal funds are not appropriated, continued, or available at a sufficient level to fund this contract; or

23.1.2 A change in federal or state law relevant to this contract occurs; or

23.1.3 A material change of the parties to the contract occurs; or

23.1.4 By request of the Contractor.

23.2 Each party under this contract may terminate the contract, in whole or in part, at any time, for its convenience without penalty or recourse by providing the following written notice.

23.2.1 The Department will provide written notice to the Contractor at least thirty (30) calendar days prior to the effective date of such termination.

23.2.2 The Contractor shall provide written notice to the Department at least sixty (60) calendar days prior to the effective date of such termination.

23.3 In the event of termination, the Department may exercise the rights set forth in 2 CFR § 200.315(b) to reproduce, publish, or otherwise use copyrighted material prepared, furnished or completed by the Contractor pursuant to the terms of the contract, and may authorize others to do the same. The Department may also exercise the rights set forth in 2 CFR § 200.315(d) to obtain, reproduce, or otherwise use the data prepared, furnished, or produced by the Contractor pursuant to the terms of the contract, and may authorize others to do the same. The Contractor shall be entitled to receive compensation for services and/or supplies performed in accordance with the contract

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prior to the effective date of the termination and for all non-cancelable obligations incurred pursuant to the contract prior to the effective date of the termination.

24. TRANSITION

24.1 Upon award of the contract, the Contractor shall work with the Department and any other organizations designated by the Department to ensure an orderly transition of services and responsibilities under the contract and to ensure the continuity of those services required by the Department.

24.1.1 Upon expiration, termination, or cancellation of the contract, the Contractor shall assist the Department to ensure an orderly and smooth transfer of responsibility and continuity of those services required under the terms of the contract to an organization designated by the Department.

25. SUBCONTRACTING

25.1 Any subaward and/or subcontract shall include appropriate provisions and contractual obligations to ensure the successful fulfillment of all contractual obligations agreed to by the Contractor and the Department, including the civil rights requirements set forth in 19 CSR 10-2.010 (5) (A)-(L), if applicable, and provided that the Department approves the arrangement prior to finalization. The Contractor shall ensure that the Department is indemnified, saved and held harmless from and against any and all claims of damage, loss, and cost (including attorney fees) of any kind related to a subaward and/or subcontract in those matters described herein. The Contractor shall expressly understand and agree that the responsibility for all legal and financial obligations related to the execution of a subaward and/or subcontract rests solely with the Contractor; and the Contractor shall ensure and maintain documentation that any and all subawardees and/or subcontractors comply with all requirements of this contract. The Contractor agrees and understands that utilization of a subawardee and/or subcontractor to provide any of the equipment or services in this contract shall in no way relieve the Contractor of the responsibility for providing the equipment or services as described and set forth herein.

25.2 Pursuant to subsection 1 of section 285.530, RSMo, no Contractor, subawardee, and/or subcontractor shall knowingly employ, hire for employment, or continue to employ an unauthorized alien to perform work within the state of Missouri. In accordance with sections 285.525 to 285.550, RSMo, a general Contractor, subawardee, and/or subcontractor of any tier shall not be liable when such Contractor, subawardee, and/or subcontractor contracts with its direct subawardee and/or subcontractor who violates subsection 1 of section 285.530, RSMo, if the contract binding the Contractor and the subawardee and/or subcontractor affirmatively states that:

25.2.1 The direct subawardee and/or subcontractor is not knowingly in violation of subsection 1 of section 285.530, RSMo, and shall not henceforth be in such violation.

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25.2.2 The Contractor, subawardee, and/or subcontractor receives a sworn affidavit under the penalty of perjury attesting to the fact that the direct subawardee’s and/or subcontractor’s employees are lawfully present in the United States.

25.3 The Contractor shall be responsible for ensuring that any subawardee(s) and/or subcontractor(s) are appropriately qualified and licensed or certified, as required by state, federal or local law, statute, or regulation, respective to the services to be provided through this contract. The Contractor shall make documentation of such licensure or certification available to the Department upon request.

25.4 The Contractor shall notify all subawardee(s) and/or subcontractor(s) of applicable Office of Management and Budget (OMB) administrative requirements, cost principles, other applicable federal rules and regulations, and funding source information as included herein.

26. SUBSTITUTION OF PERSONNEL

26.1 The Contractor agrees and understands that the Department’s agreement to the contract is predicated in part on the utilization of the specific individual(s) and/or personnel qualifications identified in the application. Therefore, the Contractor agrees that no substitution of such specific key individual(s) and/or personnel qualifications shall be made without the prior written approval of the Department. The Contractor further agrees that any substitution made pursuant to this paragraph must be equal or better than originally proposed and that the Department’s approval of a substitution shall not be construed as an acceptance of the substitution’s performance potential. The Department agrees that an approval of a substitution will not be unreasonably withheld.

27. PARTICIPATING ENTITIES

27.1 The Contractor must comply with any Organization for the Blind/Sheltered Workshop and/or Service-Disabled Veteran Business Enterprise (SDVE) participation levels committed to in the Contractor’s awarded application.

27.1.1 The Contractor shall prepare and submit to the Department a report detailing all payments made by the Contractor to Organizations for the Blind/Sheltered Workshops and/or SDVEs participating in the contract for the reporting period. The Contractor must submit the report on a monthly basis, unless otherwise determined by the Department.

27.1.2 The Department will monitor the Contractor’s compliance in meeting the Organizations for the Blind/Sheltered Workshop and SDVE participation levels committed to in the Contractor’s awarded application. If the Contractor’s payments to the participating entities are less than the amount committed, the Department may cancel the contract and/or suspend or debar the Contractor from participating in future applications, or retain payments to the Contractor in an amount equal to the value of the participation commitment less actual payments made by the Contractor to the participating entity. If

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the Department determines that the Contractor becomes compliant with the commitment, any funds retained as stated above, will be released.

27.1.3 If a participating entity fails to retain the required certification or is unable to satisfactorily perform, the Contractor must obtain participation from other organizations for the blind/sheltered workshops or other SDVEs to fulfill the participation requirements committed to in the Contractor’s awarded application.

a) The Contractor must obtain the written approval of the Department for any new entities. This approval shall not be arbitrarily withheld.

b) If the Contractor cannot obtain a replacement entity, the Contractor must submit documentation to the Department detailing all efforts made to secure a replacement. The Department shall have sole discretion in determining if the actions taken by the Contractor constitute a good faith effort to secure the required participation and whether the contract will be amended to change the Contractor’s participation commitment.

27.1.4 No later than 30 days after the effective date of the first renewal period, the Contractor must submit an affidavit to the Department. The affidavit must be signed by the director or manager of the participating Organizations for the Blind/Sheltered Workshop verifying provision of products and/or services and compliance of all Contractor payments made to the Organizations for the Blind/Sheltered Workshops. The contactor may use the affidavit available on the Office of Administration/Division of Purchasing’s website at http://oa.mo.gov/sites/default/files/bswaffidavit.doc or another affidavit providing the same information.

27.2 Minority Business Enterprise (MBE)/Woman Owned Business Enterprise (WBE) Participation

27.2.1 A listing of minority and women vendors certified by the Department is available on the Internet at:

http://oeo.mo.gov/

27.2.2 For Applicants who do not have Internet access, information regarding registered minority and women vendors can be obtained by contacting the Office of Equal Opportunity at (877) 259-2963 or (573) 751-8130.

27.2.3 In the event the Applicant proposes to subcontract for services and/or equipment described herein, the Applicant should make a good faith effort to locate and contract with certified MBEs for a minimum of 10% of the total dollar value of the contract and with WBEs for 10% of the total dollar value of the contract.

27.2.4 The Applicant should indicate the percentage level of MBE/WBE participation proposed to fulfill the requirements of the contract. The Applicant should provide

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documentation of a plan for achieving the proposed level of participation for each MBE/WBE subcontractor proposed.

28. SUBMISSION OF APPLICATIONS

28.1 Applicants must sign the RFA cover page or, if applicable, the cover page of the last amendment thereto in order to demonstrate acceptance by the Applicant of all RFA terms and conditions. Failure to do so may result in rejection of the application unless the Applicant's full compliance with those documents is indicated elsewhere within the Applicant's response.

28.1.1 The signed page one (cover page) from the original RFA and all signed amendments should be placed at the beginning of the application. These form(s) must include an original signature (preferably signed in blue ink), no stamped signatures. The signature must be that of an individual legally authorized to sign contracts for the agency.

28.2 Any foreign Applicant not having an Employer Identification Number assigned by the United States Internal Revenue Service (IRS) must submit a completed IRS Form W-8 prior to or with the submission of their application in order to be considered for award.

28.3 The Applicant should provide its Data Universal Numbering System (DUNS) number to the Department by completing Exhibit 3, which is attached hereto and is incorporated by reference as if fully set forth herein.

28.4 To facilitate the evaluation process, the Applicant is encouraged to submit application information by sections that correspond with the individual evaluation categories described herein. The Applicant is cautioned that it is the Applicant’s sole responsibility to submit necessary information. The Department is under no obligation to solicit any information if it is not included with the application. The Applicant’s failure to submit information with the application, including pricing and renewal information, may cause an adverse impact on the evaluation of the application.

28.4.1 Each distinctive section should be titled with each individual evaluation category and all material related to that category should be included therein.

28.5 The application should be page numbered.

28.6 The application should be typed.

28.7 In preparing an application, the Applicant should be mindful of document preparation efforts for imaging purposes and storage capacity. The Applicant should limit application content to items that provide substance, quality of content, and clarity of information.

28.8 Do not staple the application.

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28.9 The Department recognizes the limited nature of our resources and the leadership role of government agencies in regard to the environment. Accordingly, the Applicant is requested to print the application double-sided using recycled paper, if possible, and minimize or eliminate the use of non-recyclable materials such as plastic report covers, plastic dividers, vinyl sleeves, and binding. Lengthy applications may be submitted in a notebook or binder.

28.10 The Applicant should include five (5) additional copies along with the original application. The Applicant should include completed exhibits, forms, and other information concerning the application, including completed Pricing Page Analysis, with the application.

28.10.1 The front cover of the original application should be labeled “original” and the front cover of all copies should be labeled “copy”.

28.11 Any information submitted with the application, regardless of the format or placement of such information, may be considered in making decisions related to the responsiveness and merit of an application and the award of a contract.

28.12 Applications may be submitted through the U.S. Postal Service. However, mailing applications to the P.O. Box does not guarantee receipt of the application document by the Procurement Unit before the required receipt date and time.

28.13 The outermost, sealed envelope should clearly identify “RFA #2027” in the lower left corner of the envelope.

28.14 Faxed or emailed applications will not be accepted.

28.15 The Department must receive the application in a sealed envelope on or before the return due date and time published on the front page of the RFA at the address listed on the cover page of the application. The application return due date and time may also be referred to as the application opening date and time.

28.16 Applications received after the receipt date and time as published on the front page of the RFA will not be considered or evaluated.

28.17 Pursuant to section 610.021, RSMo, the application shall be considered an open record after the applications are opened. Therefore, the Applicant is advised not to include any information that the Applicant does not want to be viewed by the public, including personal identifying information such as social security numbers.

28.18 The Applicant is cautioned when submitting pre-printed terms and conditions or other type material to make sure such documents do not contain other terms and conditions which conflict with those of the RFA and its contractual requirements. The Applicant agrees that in the event of conflict between any of the Applicant's terms and conditions and those contained in the RFA, that the RFA shall govern. Taking exception to the

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State's terms and conditions may render an Applicant's application non-responsive and remove it from consideration for award.

28.19 The Applicant hereby covenants that at the time of the submission of the application the Applicant has no other contractual relationships that would create any actual or perceived conflict of interest. The Applicant further agrees that during the term of the contract neither the Applicant nor any of its employees shall acquire any other contractual relationships that create such a conflict.

28.20 In the event that the Applicant is an agency of state government or other such political subdivision which is prohibited by law or court decision from complying with certain provisions of a RFA, such an Applicant may submit an application that contains a list of statutory limitations and identification of those prohibitive clauses. The Applicant should include a complete list of statutory references and citations for each provision of the RFA that is affected by this paragraph. The statutory limitations and prohibitive clauses may (1) be requested to be clarified in writing by the Department or (2) be accepted without further clarification if the statutory limitations and prohibitive clauses are deemed acceptable by the Department.

29. APPLICATION WITHDRAWAL

29.1 An application that has been delivered to the Department may only be withdrawn by a signed, written document on company letterhead transmitted via mail, e-mail, or facsimile that the applicant delivers to the Department. Telephone requests to withdraw an application will not be accepted.

30. APPLICATION EVALUATION

30.1 All applications will be reviewed and scored by an evaluation committee.

30.2 The Department reserves the right to request clarification of any portion of the Applicant's response in order to verify the intent of the Applicant. The Applicant is cautioned, however, that its response may be subject to acceptance or rejection without further clarification.

30.3 When evaluating an application, the Department reserves the right to consider relevant information and fact, whether gained from an application, from an Applicant, from Applicant's references, or from any other source.

30.4 After determining that an application satisfies the mandatory requirements stated in the RFA, the evaluator(s) shall use both objective analysis and subjective judgment in conducting a comparative assessment of the application in accordance with the evaluation criteria stated below. The contracts shall be awarded to the lowest and best applications.

30.5 Application evaluation will be based on a 200 point total to be applied as follows:

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Experience and Reliability----------------------Up to 25 pointsExpertise of Personnel--------------------------Up to 35 pointsMethod of Performance-------------------------Up to 40 pointsCost------------------------------------------------Up to 100 points

30.6 Evaluation of Applicant’s Experience and Reliability

30.6.1 Experience and reliability of the Applicant’s organization will be considered subjectively in the evaluation process. Therefore, the Applicant is advised to submit information concerning the Applicant’s organization and information documenting the Applicant’s experience in past performances, especially those performances related to the requirements of this RFA. If the Applicant is proposing an entity other than the Applicant to perform the required services, the Applicant should also submit the information requested for such proposed subcontractor.

a. The Applicant should provide information about the Applicant’s organization on Exhibit 4.

b. The Applicant should provide information related to previous and current services/contracts of the Applicant or Applicant’s proposed subcontractor where performance was similar to the required services of this RFA. The information may be shown on Exhibit 5 or in a similar manner.

1) As part of the evaluation process, the Department may contact the Applicant’s references, including references not listed or identified within the Applicant’s application but who have current or previous experiences with the Applicant.

2) The Applicant shall agree and understand that the Department is not obligated to contact the Applicant’s references.

30.7 Evaluation of Expertise of Applicant’s Personnel

30.7.1 The qualifications of the personnel proposed by the Applicant to perform the requirements of this RFA, whether from the Applicant’s organization or from a proposed subcontractor, will be subjectively evaluated. Therefore, the Applicant should submit detailed information related to the experience and qualifications, including education and training, of proposed personnel.

a. The Applicant should provide the information requested on Exhibit 6 for each key person proposed to provide the services required herein. If additional personnel resources are available, the Applicant may provide information for such personnel by completing Exhibit 7.

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1) The information provided should be structured to emphasize relevant qualifications and experience of the personnel in completing contracts/performing services of a similar size and scope to the requirements of this RFA.

a) The information submitted should clearly identify previous experience of the person in performing similar services and should include beginning and ending dates, a description of the role of the person in such performances, results of the services performed, and whether the person is proposed for the same services for the Department.

b. If personnel are not yet hired, the Applicant should provide detailed descriptions of the required employment qualifications; and detailed job descriptions of the position to be filled, including the type of person proposed to be hired.

30.7.2 The Applicant shall complete and submit Exhibit 8, Miscellaneous Information regarding services being performed at sites outside the United States.

30.7.3 The Applicant must be in compliance with the laws regarding conducting business in the State of Missouri. The Applicant shall provide documentation of compliance upon request by the Department. The compliance to conduct business in the state shall include, but not necessarily be limited to:

a. Registration of business name (if applicable)

b. Certificate of authority to transact business/certificate of good standing (if applicable)

c. Taxes (e.g., city/county/state/federal)

d. State and local certifications (e.g., professions/occupations/activities)

e. Licenses and permits (e.g., city/county license, sales permits)

f. Insurance (e.g., worker’s compensation/unemployment compensation)

30.8 Evaluation of Method of Performance

30.8.1 Applications will be subjectively evaluated based on the Applicant’s distinctive plan for performing the requirements of the RFA. Therefore, the Applicant should present a written narrative that demonstrates the method or manner in which the Applicant proposes to satisfy these requirements. The language of the narrative should be straightforward and limited to facts, solutions to problems, and plans of action.

30.8.2 Method of Performance - Exhibit 9 is provided for the Applicant’s use in providing information about the proposed method of performance. The Applicant should present

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a detailed description of all products and services proposed in the response to this RFA. It is the Applicant's responsibility to make sure all products proposed are adequately described in order to conduct an evaluation of the application to insure its compliance with mandatory technical specifications. It should not be assumed that the evaluator has specific knowledge of the products proposed; however, the evaluator does have sufficient technical background to conduct an evaluation when presented complete information.

30.8.3 The Applicant may submit preprinted marketing materials with the application. However, the Applicant is advised that such brochures normally do not address the needs of the evaluators with respect to the technical evaluation process and the specific responses which have been requested of the Applicant. The Applicant is strongly discouraged from relying on such materials in presenting products and services for consideration by the state.

a. It is the Applicant’s responsibility to provide detailed information about how the item application meets the specifications presented herein. If preprinted marketing materials do not specifically address each specification, the Applicant should provide detailed information to ensure that the product meets the state’s mandatory requirements. In the event this information is not submitted with the application, the procurement officer may, but is not required to, seek written clarification from the Applicant to provide assurance that the product application meets specifications.

30.8.4 It is the Applicant’s responsibility to submit an application that meets all mandatory specifications stated herein. The Applicant should clearly identify any and all deviations from both the mandatory and desirable specifications stated in the RFA. Any deviation from a mandatory requirement may render the application non-responsive. Any deviation from a desirable specification may be reviewed by the state as to its acceptability and impact on competition.

a. A descriptive brochure may not be acceptable as clear identification of deviations from the written specification.

30.8.5 The Applicant should also provide an organizational chart showing the staffing and lines of authority for the key personnel to be used. The relationship of service personnel to management and to support personnel should be clearly illustrated.

30.9 Evaluation of Cost

30.9.1 The cost evaluation shall be based on the Guaranteed Not-To-Exceed Total Price stated on the Pricing Page Analysis, Exhibit 1 for each Track program and potential contract period for each service area(s) applying for.

a. The evaluation of cost will include the original and any potential renewal periods.

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b. Cost evaluation points shall be determined from the result of the calculation stated above using the following formula:

Lowest Responsive Applicant’s Price

X

Maximum Cost Evaluation points (100)

= Assigned Cost PointsApplicant’s Price

30.9.2 The Applicant shall complete and return the Price Analysis, Exhibit 1 or present the same information in a similar format.

30.10 Any pricing information submitted by an Applicant shall be subject to evaluation if deemed by the Department to be in its best interest.

30.11 Preference for Organizations for the Blind and Sheltered Workshops - Pursuant to section 34.165, RSMo, and 1 CSR 40-1.050, a five to fifteen (5-15) bonus point preference shall be granted to Applicants including products and/or services manufactured, produced or assembled by a qualified nonprofit organization for the blind established pursuant to 41 U.S.C. sections 46 to 48c or a sheltered workshop holding a certificate of approval from the Department of Elementary and Secondary Education pursuant to section 178.920, RSMo.

30.11.1 In order to qualify for the five to fifteen (5-15) bonus points, the following conditions must be met and the following evidence must be provided:

a. The Applicant must either be an organization for the blind or sheltered workshop or must be proposing to utilize an organization for the blind/sheltered workshop as a subcontractor and/or supplier in an amount that must equal, at a minimum, the greater of $5,000 or 2% of the total dollar value of the contract for purchases not exceeding $10 million.

b. The services performed or the products provided by the organization for the blind or sheltered workshop must provide a commercially useful function related to the delivery of the contractually required service/product in a manner that will constitute an added value to the contract and shall be performed/provided exclusive to the performance of the contract. Therefore, if the services performed or the products provided by the organization for the blind or sheltered workshop are utilized, to any extent, in the Applicant’s obligations outside of the contract, it shall not be considered a valid added value to the contract and shall not qualify as participation in accordance with this clause.

c. If the Applicant is proposing participation by an organization for the blind or sheltered workshop, in order to receive evaluation consideration for participation by the organization for the blind or sheltered workshop, the Applicant must provide the requested information with the bid.

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d. A sliding scale for the award of points shall range from a minimum of five (5) points to a maximum of fifteen (15) points. The award of the minimum five (5) points shall be based on the bid containing a commitment that the participating nonprofit organization or workshop is providing the greater of two percent (2%) or five thousand dollars ($5,000) of the total contract value of bids for purchases not exceeding ten (10) million dollars.

30.11.2 Where the commitment in the bid exceeds the minimum level set forth in section 34.165, RSMo to obtain five (5) points, the awarded points shall exceed the minimum five (5) points, up to a maximum of fifteen (15) points. As the statute sets out a minimum of five (5) points for a minimum two percent (2%) commitment, each percent of commitment is worth two and one-half (2.5) points. The formula to determine the awarded points for commitments above the two percent (2%) minimum shall be calculated based on the commitment in the bid (which in the formula will be expressed as a number [Applicant’s Commitment Number below], not as a percentage) times two and one-half (2.5) points:

Applicant’s Commitment Number x 2.5 points = Awarded Points

Examples: A commitment of three percent (3%) would be calculated as: 3 x 2.5 points = 7.5 awarded points. A commitment of five and one-half percent (5.5%) would be calculated as: 5.5 x 2.5 points = 13.75 awarded points. If, instead of a percentage, an Applicant’s bid lists a dollar figure that is over the minimum amount, the dollar figure shall be converted into the percentage of the Applicant’s total contract value for calculation of the awarded points. Commitments at or above six percent (6%) receive the maximum of fifteen (15) points.

a. Participation Commitment – The Applicant must complete Exhibit 10, Participation Commitment, by identifying the organization for the blind or sheltered workshop, the amount of participation committed, and the commercially useful products/services to be provided by the listed organization for the blind or sheltered workshop. If the Applicant submitting the bid is an organization for the blind or sheltered workshop, the Applicant must be listed in the appropriate table on the Participation Commitment Form.

b. Documentation of Intent to Participate – The Applicant must either provide a properly completed Exhibit 11 Documentation of Intent to Participate Form or must provide a letter of intent recently signed by the proposed Organization for the Blind or Sheltered Workshop which: (1) must describe the products/services the organization for the blind/sheltered workshop will provide and (2) should include evidence of the organization for the blind/sheltered workshop qualifications (e.g. copy of certificate or Certificate Number for Missouri Sheltered Workshop).

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NOTE: If the Applicant submitting the bid is an organization for the blind or sheltered workshop, the Applicant is not required to complete Exhibit 11, Documentation of Intent to Participate Form or provide a letter of intent.

30.11.3 The following websites provide information regarding Missouri sheltered workshops:

a. Listing of Missouri Sheltered Workshops: http://dese.mo.gov/special-education/sheltered-workshops/directories

b. Missouri Sheltered Workshop Products/Services Locator: http://moworkshops.org/services.html

30.11.4 The websites for the Missouri Lighthouse for the Blind and the Alphapointe Association for the Blind can be found at the following Internet addresses:

http://www.lhbindustries.comhttp://www.alphapointe.org

30.11.5 Commitment – If the Applicant’s bid is awarded, the organization for the blind or sheltered workshop participation committed to by the Applicant on Exhibit 10, Participation Commitment, shall be interpreted as a contractual requirement.

30.12 Service-Disabled Veteran Business Enterprises (SDVEs) - Pursuant to section 34.074, RSMo, and 1 CSR 40-1.050, the state agency has a goal of awarding three (3) percent of all contracts for the performance of any job or service to qualified service-disabled veteran business enterprises (SDVEs). A three (3) point bonus preference shall be granted to Applicants including products and/or services manufactured, produced or assembled by a qualified SDVE.

30.12.1 In order to qualify for the three bonus points, the following conditions must be met and the following evidence must be provided:

a. The Applicant must either be an SDVE or must be proposing to utilize an SDVE as a subcontractor and/or supplier that provides at least three percent (3%) of the total contract value.

b. The services performed or the products provided by the SDVE must provide a commercially useful function related to the delivery of the contractually-required service/product in a manner that will constitute an added value to the contract and shall be performed/provided exclusive to the performance of the contract. Therefore, if the services performed or the products provided by the SDVE are utilized, to any extent, in the Applicant’s obligations outside of the contract, it shall not be considered a valid added value to the contract and shall not qualify as participation in accordance with this clause.

c. In order to receive evaluation consideration for participation by an SDVE, the Applicant must provide the following information with the bid:

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1) Participation Commitment - The Applicant must complete Exhibit 10, Participation Commitment, by identifying each proposed SDVE, the committed percentage of participation for each SDVE, and the commercially useful products/services to be provided by the listed SDVE. If the Applicant submitting the bid is a qualified SDVE, the Applicant must be listed in the appropriate table on the Participation Commitment Form.

2) Documentation of Intent to Participate – The Applicant must either provide a properly completed Exhibit 11, Documentation of Intent to Participate Form or must provide a letter of intent recently signed by the proposed SDVE which: (1) must describe the products/services the SDVE will provide and (2) must include the SDV Documents described below as evidence that the SDVE is qualified, as defined herein.

3) Service-Disabled Veteran (SDV) Documents – If a participating organization is an SDVE, unless previously submitted within the past three (3) years to the state agency or to the Office of Administration, Division of Purchasing, the Applicant must provide the following Service-Disabled Veteran (SDV) documents.

a) a copy of the SDV’s Certificate of Release or Discharge from Active Duty (DD Form 214), and a copy of the SDV’s disability rating letter issued by the Department of Veterans Affairs establishing a service connected disability rating, or a Department of Defense determination of service connected disability.

NOTE:

i. If the Applicant submitting the bid is a qualified SDVE, the Applicant must include the SDV Documents as evidence that the Applicant qualifies as an SDVE. However, the Applicant is not required to complete Exhibit 11, Documentation of Intent to Participate Form or provide a letter of intent.

ii. If the SDVE and SDV are listed on the following Internet address, the Applicant is not required to prove the SDV Documents listed above.

http://oa.mo.gov/sites/default/files/sdvelisting.pdf

30.12.2 Commitment – If awarded a contract, the SDVE participation committed to by the Applicant on Exhibit 10, Participation Commitment, shall be interpreted as a contractual requirement.

30.12.3 Definition - Qualified SDVE:

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a. SDVE is doing business as a Missouri firm, corporation, or individual or maintaining a Missouri office or place of business, not including an office of a registered agent;

b. SDVE has not less than fifty-one percent (51%) of the business owned by one (1) or more service-disabled veterans (SDVs) or, in the case of any publicly-owned business, not less than fifty-one percent (51%) of the stock of which is owned by one (1) or more SDVs;

c. SDVE has the management and daily business operations controlled by one (1) or more SDVs;

d. SDVE has a copy of the SDV’s Certificate of Release or Discharge from Active Duty (DD Form 214), and a copy of the SDV’s disability rating letter issued by the Department of Veterans Affairs establishing a service connected disability rating, or a Department of Defense determination of service connected disability; and

e. SDVE possesses the power to make day-to-day as well as major decisions on matters of management, policy, and operation.

30.13 Pursuant to 34.060 RSMo, a preference will be given to materials, products, supplies, provisions and all other articles produced, manufactured, made or grown within the State of Missouri and to all firms, corporations or individuals doing business as Missouri firms, corporations or individuals. Such preference shall be given when quality is equal or better and delivered price is the same or less.

30.14 Award Process:

30.14.1 Any award of a contract shall be made by notification from the Department to the successful Applicant.

30.14.2 The Department will officially notify Applicants not receiving a contract in writing. The only official position of the Department will be issued in writing and signed by the Director of Administration (or designated representative) of the Missouri Department of Health and Senior Services. No other means of communication, whether oral or written, shall be construed as a formal or official response or statement.

30.14.3 Contracts will be awarded on a competitive basis with the lowest and best application for each services area receiving an award.  Based on the availability of funds, additional awards shall be made to the next lowest and best application(s).

30.14.4 In the event all Applicants fail to meet the same mandatory requirement in an RFA, the Department reserves the right, at its sole discretion, to waive that requirement for all Applicants and to proceed with the evaluation.

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30.14.5 The Department reserves the right to reject any and all applications.

30.14.6 Any application award protest must be received within ten (10) business days after the date of award in accordance with the requirements of 1 CSR 40-1.050 (9).

30.14.7 The final determination of contract award(s) shall be made by Department.

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RFA #2027 Attachment ACERTIFICATIONS

1. GENERAL

1.1 To the extent that this contract involves the use, in whole or in part, federal funds, the signature of the Contractor’s authorized representative on the contract signature page indicates compliance with the following Certifications and special provisions.

2. CONTRACTOR’S CERTIFICATION REGARDING SUSPENSION AND DEBARMENT

2.1 The Contractor certifies that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract by any Federal department or agency pursuant to 2 CFR Part 180.

2.2 The Contractor shall include these certification requirements regarding debarment, suspension, ineligibility, and voluntary exclusion in all lower tier covered transactions.

2.3 If the Contractor enters into a covered transaction with another person at the next lower tier, the Contractor must verify that the person with whom it intends to do business is not excluded or disqualified by:

2.3.1 Checking the System of Award Management (SAM) https://www.sam.gov; or

2.3.2 Collecting a certification from that person; or

2.3.3 Adding a clause or condition to the covered transaction with that person.

3. CONTRACTOR’S CERTIFICATION REGARDING LOBBYING

3.1 The Contractor certifies that no Federal appropriated funds have been paid or will be paid, by or on behalf of the Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, or the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

3.2 The Contractor certifies that no funds under this contract shall be used to pay for any activity to support or defeat the enactment of legislation before the Congress, or any State or local legislature or legislative body. The Contractor shall not use any funds under this contract to pay for any activity to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government.

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3.3 The Contractor certifies that no funds under this contract shall be used to pay the salary or expenses of the Contractor, or an agent acting for the Contractor who engages in any activity designed to influence the enactment of legislation or appropriations proposed or pending before the Congress, or any State, local legislature or legislative body, or any regulation, administrative action, or Executive Order issued by the executive branch of any State or local government.

3.4 The above prohibitions include any activity to advocate or promote any proposed, pending or future Federal, State or local tax increase, or any proposed, pending or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.

3.5 If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with any Federal contract, grant, loan, or cooperative agreement, the Contractor shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions.

3.6 The Contractor shall require that the language of this section be included in the award documents for all subawards at all levels (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

3.7 This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

4. CONTRACTOR’S CERTIFICATION REGARDING A DRUG FREE WORKPLACE

4.1 The Contractor certifies it shall provide a drug free workplace in accordance with the Drug Free Workplace Act of 1988, 41 U.S.C. Chapter 81, and all applicable regulations. The Contractor is required to report any conviction of employees providing services under this contract under a criminal drug statute for violations occurring on the Contractor’s premises or off the Contractor’s premises while conducting official business. The Contractor shall report any conviction to the Department within five (5) working days after the conviction. Submit reports to:

Missouri Department of Health and Senior ServicesDivision of Administration, Grants Accounting UnitP.O. Box 570920 Wildwood DriveJefferson City, Missouri 65102-0570

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5. CONTRACTOR’S CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE

5.1 The Pro-Children Act of 1994, (Public Law 103-227, 20 U.S.C. §§ 6081-6084), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The Pro-Children Act also applies to children’s services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The Pro-Children Act does not apply to children’s services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or Medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the Pro-Children Act may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity.

5.2 The Contractor certifies that it will comply with the requirements of the Pro-Children Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Pro-Children Act.

5.3 The Contractor agrees that it will require that the language of this certification be included in any subcontract or subaward that contains provisions for children’s services and that all subrecipients shall certify accordingly. Failure to comply with the provisions of the Pro-Children Act law may result in the imposition of a civil monetary penalty of up to $1,000 per day.

6. CONTRACTOR’S CERTIFICATION REGARDING NON-DISCRIMINATION 6.1 The Contractor shall comply with all federal and state statutes, regulations and

executive orders relating to nondiscrimination and equal employment opportunity to the extent applicable to the contract. These include but are not limited to:

6.1.1 Title VI of the Civil Rights Act of 1964 (P.L. 88-352, 42 U.S.C. § 2000d et seq.) which prohibits discrimination on the basis of race, color, or national origin (this includes individuals with limited English proficiency) in programs and activities receiving federal financial assistance and Title VII of the Act which prohibits discrimination on the basis of race, color, national origin, sex, or religion in all employment activities;

6.1.2 Equal Pay Act of 1963 (P.L. 88 -38, as amended, 29 U.S.C. § 206 (d));

6.1.3 Title IX of the Education Amendments of 1972, as amended (20 U.S.C §§ 1681-1683 and 1685-1686) which prohibits discrimination on the basis of sex;

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6.1.4 Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794) and the Americans with Disabilities Act of 1990, as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12101 et seq.) as implemented by all applicable regulations;

6.1.5 The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107) which prohibits discrimination on the basis of age;

6.1.6 Equal Employment Opportunity – E.O. 11246, as amended;

6.1.7 Missouri State Regulation, 19 CSR 10-2.010, Civil Rights Compliance Requirements;

6.1.8 Missouri Governor’s E.O. #05-30 (excluding paragraph 1, which was superseded by E.O. #10-24);

6.1.9 Missouri Governor’s E.O. #10-24; and

6.1.10 The requirements of any other nondiscrimination federal and state statutes, regulations and executive orders which may apply to the services provided via the contract.

7. CONTRACTOR’S CERTIFICATION REGARDING EMPLOYEE WHISTLEBLOWER PROTECTIONS

7.1 The Contractor shall comply with the provisions of 41 U.S.C. 4712 that states an employee of a Contractor, subcontractor, grantee, or subgrantee may not be discharged, demoted or otherwise discriminated against as a reprisal for “whistleblowing”. In addition, whistleblower protections cannot be waived by any agreement, policy, form, or condition of employment.

7.2 The Contractor’s employees are encouraged to report fraud, waste, and abuse. The Contractor shall inform their employees in writing they are subject to federal whistleblower rights and remedies. This notification must be in the predominant native language of the workforce.

7.3 The Contractor shall include this requirement in any agreement made with a subcontractor or subgrantee.

8. CLEAN AIR ACT AND WATER POLLUTION CONTROL ACT

8.1 The Contractor shall comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.).

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RFA #2027 Attachment BSUBRECIPIENT SPECIAL CONDITIONS

1. The Department of Health and Senior Services has determined that this contract is subrecipient in nature as defined in the 2 CFR § 200.330. To the extent that this contract involves the use, in whole or in part, of federal funds, the Contractor shall comply with the following special conditions.

1.1 The Contractor shall comply with all applicable implementing regulations, and all other laws, regulations and policies authorizing or governing the use of any federal funds paid to the Contractor through this contract. The Contractor shall ensure compliance with U.S. statutory and public policy requirements, including but not limited to, those protecting public welfare, the environment, and prohibiting discrimination. See the Federal Agency’s Notice of Grant Award at http://health.mo.gov/contractorresources/nga for the terms and conditions of the federal award(s) governing this contract. Refer to the Contract Funding Source(s) report enclosed with the contract for a listing of the applicable federal award numbers.

1.2 In performing its responsibilities under this contract, the Contractor shall fully comply with the Office of Management and Budget (OMB) Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (2 CFR Part 200, as applicable, including any subsequent amendments.

1.3 The Contractor shall send audit reports, other than their Single Audit Report, to the Department of Health and Senior Services, Division of Administration, P.O. Box 570, Jefferson City, MO 65102 each contract year. If a Single Audit is required, the Contractor must submit the Single Audit Report according to 2 CFR § 200.512. The Contractor shall return to the Department any funds disallowed in an audit of this contract.

1.4 The Contractor shall comply with the public policy requirements as specified in the Department of Health and Human Services (HHS) Grants Policy Statement which is incorporated herein as if fully set forth. http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf

1.5 The Contractor shall be responsible for any disallowances, questioned costs, or other items, including interest, not allowed under the federal award or this contract. The Contractor shall return to the Department any funds disallowed within ninety days of notification by the Department to return such funds.

1.6 The Contractor shall notify the Department in writing within 30 days after a change occurs in its primary personnel involved in managing this contract.

1.7 The Contractor shall notify the Department in writing of any violation of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting federal monies under this contract. Failure by the Contractor to disclose such violations may result in the Department taking action as described in 2 CFR § 200.338 Remedies for Noncompliance.

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RFA #2027 Attachment BSUBRECIPIENT SPECIAL CONDITIONS

1.8 The Contractor shall comply with Trafficking Victims Protection Act of 2000 (22 U.S.C. Chapter 78), as amended. This law applies to any private entity. A private entity includes any entity other than a State, local government, Indian tribe, or foreign public entity, as defined in 2 CFR § 175.25. The subrecipient and subrecipients’ employees may not:

1.8.1 Engage in severe forms of trafficking in persons during the period of time that the award is in effect;

1.8.2 Procure a commercial sex act during the period of time that the award is in effect; or

1.8.3 Use forced labor in the performance of the award or subawards under the award.

1.8.4 The Contractor must include the requirements of this paragraph in any subaward made to a private entity.

1.9 The Contractor shall comply with 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations, as applicable.

1.10 A Contractor that is a Department or agency of a political subdivision of a state and its contractors must comply with Section 6002 of the Solid Waste Disposal Act (42 U.S.C. § 6962), as amended by the Resource Conservation and Recovery Act (P.L. 94-580). The requirements of Section 6002 relate solely to procuring items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247.

1.11 The Contractor shall provide its Data Universal Numbering System (DUNS) number to the Department. If the Contractor is an exempt individual as per 2 CFR § 25.110(b), the Contractor shall notify the Department of its exemption. Pursuant to 2 CFR Part 25, no entity may receive a subaward unless the entity has provided its DUNS number. The Department shall withhold the award of this contract until the Contractor submits the DUNS number to the Department and the Department has verified the DUNS.

1.12 Equipment

1.12.1 Title to equipment purchased by the Contractor for the purposes of fulfilling contract services vests in the Contractor upon acquisition, subject to the conditions that apply as set forth in 2 CFR § 200.313. The Contractor must obtain written approval from the Department prior to purchasing equipment with a cost greater than $1,000. The repair and maintenance of purchased equipment will be the responsibility of the Contractor. Upon satisfactory completion of the contract, if the current fair market value (FMV) of the equipment purchased by the Contractor is less than $5,000, the Contractor has no further obligation to the Department. The Contractor may sell or retain items it purchased with a current FMV greater than $5,000, but the Contractor may be required to reimburse the Department for costs up to the current value of the equipment.

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RFA #2027 Attachment BSUBRECIPIENT SPECIAL CONDITIONS

1.12.2 Equipment purchased by the Department and placed in the custody of the Contractor shall remain the property of the Department. The Contractor must ensure these items are safeguarded and maintained appropriately, and return such equipment to the Department at the end of the program.

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RFA #2027 Attachment C

Service Areas and estimated Alzheimer’s disease population per countyRegion 1   Region 2   Region 3   Region 4  Andrew 320 Adair 360 Barry 735 Bollinger 178Atchison 131 Audrain 438 Barton 226 Butler 683Benton 545 Boone 1907 Bates 321 Cape Girardeau 948

Buchanan 1367 Callaway 655 Cedar 336 Carter 116Caldwell 180 Camden 1128 Christian 1216 Dent 323Carroll 193 Clark 133 Dade 170 Dunklin 547Cass 1667 Cole 1120 Dallas 326 Iron 183

Chariton 172 Cooper 298 Douglas 310 Jefferson 1823Clay 3284 Crawford 360 Green 4494 Madison 212

Clinton 382 Franklin 1135 Henry 467 Mississippi 214Daviess 164 Gasconade 288 Hickory 300 New Madrid 306DeKalb 207 Howard 174 Howell 258 Pemiscot 299Gentry 136 Knox 83 Jasper 1684 Perry 285Grundy 220 Laclede 607 Lawrence 687 Reynolds 108Harrison 187 Lewis 184 McDonald 322 Ripley 273

Holt 105 Lincoln 421 Newton 1038 Scott 554Jackson 10024 Linn 261 Oregon 245 St. Francois 829Johnson 672 Macon 331 Ozark 253 St. Louis City 4770

Lafayette 616 Maries 179 Polk 540 St. Louis County 14245Livingston 303 Marion 500 Shannon 166 Ste. Genevieve 259

Mercer 81 Miller 462 St. Clair 257 Stoddard 511Nodaway 329 Moniteau 239 Stone 863 Washington 273

Pettis 655 Monroe 184 Taney 1103 Wayne 263Platte 1394 Montgomery 238 Texas 506    Ray 414 Morgan 482 Vernon 375    

Saline 398 Osage 236 Webster 555    Worth 51 Phelps 554 Wright 347    

    Pike 275            Pulaski 415            Putnam 120            Ralls 204            Randolph 392            Schuyler 80            Scotland 90            Shelby 126            St. Charles 2498            Sullivan 122            Warren 319        

24197 17598 18100 28202

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RFA #2027 Attachment C

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RFA #2027 Attachment D

DEFINITIONS OF SERVICE UNITS FOR TRACK 1

ASSESSMENT Person – one person/family being assessed for trainingUnits – one hour of assessmentUnits – one hour of reassessmentUnits – one hour of direct client consultation

CARE PLANPerson – one person with Alzheimer’s or related dementiaUnit – one completed care plan

CUSTOMIZED CAREGIVER TRAININGFamily – one person/family receiving trainingUnit – one full training block

ASSISTIVE SAFETY DEVICEPerson – one person with Alzheimer’s or related dementiaUnit for safety devices – one device or product

FOLLOW UP CONTACTPerson – one person/family contactedUnit – one contact made and received by person/family

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RFA #2027 Attachment D

DEFINITIONS OF SERVICE UNITS FOR TRACK 2

ASSESSMENT AND CARE COORDINATIONPerson – one person/family attending consultation for one loved oneUnits – one hour of assessmentUnits – one hour of reassessmentUnits – one hour of direct client consultation

RESPITE ASSISTANCEPerson – one caregiver actively receiving funds Unit for Care– one hour of family-based or in-home careUnit for Services – one hour of services provided

SAFETY AND SUPPORTIVE PROGRAMSPerson – one person with Alzheimer’s or related dementiaUnit for driving safety – one driving evaluationUnit for safety devices – one device or productUnit for wandering service – one registration with wandering prevention/Intervention services Unit for Transportation – one round trip from home and backUnit for products – one device, prescription, productUnit for Legal Assistance – one hour of legal services

ADULT DAY CAREPerson – one person attending an adult day care programUnits – one hour of adult day care participation

(A full day of daycare would be 8 hours or 8 units)

EDUCATION PROGRAMSPerson – one person/family attending an educational program

Unit – one hour of education

COUNSELING SERVICESPerson – one person receiving counselingUnits – one hour of counseling for individual with Alzheimer’s Units – one hour of counseling for caregiver or family member

OUTREACH

Person – one person given/mailed outreach materialsUnit – one specific brochure/handout/flyer etc.

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RFA #2027 Attachment E

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES Subrecipient Annual Financial Report

1. Contractor Name and Complete Address     2. Contract Number 3. Contract Period (MM/DD/YY) 4. Contractor Identifying

Number (optional)

 From: To:

     

5. DUNS Number 6. EIN 7. Report Type

   

8. TransactionsContract Expenditures:

8a. Total contract funds authorized:  

8b. Total expenditures:  

8c. Unspent balance of contract funds (line a minus b): $0.00

Match Requirements (if required by the contract):

8d. Total match required:  

8e. Total match expenditures:  

8f. Remaining match to be provided (line d minus e): $0.00

9. Remarks: Attach any explanations deemed necessary.  

10. Certification: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal Award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812).11a.Typed or Printed Name and Title of Authorized Certifying Official of the Contractor

11b.Telephone (Including Area Code)

11c.Email Address

     

 11d. Signature of Authorized Certifying Official of the Contractor 11e. Date Report Submitted

(MM/DD/YY) 

 

MO 580-3091 (05-17)

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RFA #2027 Attachment F

1. Business Associate Provisions

1.1 Health Insurance Portability and Accountability Act of 1996, as amended - The state agency and the Contractor are both subject to and must comply with provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH) (PL-111-5) (collectively, and hereinafter, HIPAA) and all regulations promulgated pursuant to authority granted therein. The Contractor constitutes a “Business Associate” of the state agency. Therefore, the term, “contractor” as used in this section shall mean “Business Associate.”

1.1.1 The Contractor agrees that for purposes of the Business Associate Provisions contained herein, terms used but not otherwise defined shall have the same meaning as those terms defined in 45 CFR Parts 160 and 164 and 42 U.S.C. §§ 17921 et. seq. including, but not limited to the following:

a. “Access”, “administrative safeguards”, “confidentiality”, “covered entity”, “data aggregation”, “designated record set”, “disclosure”, “hybrid entity”, “information system”, “physical safeguards”, “required by law”, “technical safeguards”, “use” and “workforce” shall have the same meanings as defined in 45 CFR 160.103, 164.103, 164.304, and 164.501 and HIPAA.

b. “Breach” shall mean the unauthorized acquisition, access, use, or disclosure of Protected Health Information which compromises the security or privacy of such information, except as provided in 42 U.S.C. § 17921. This definition shall not apply to the term “breach of contract” as used within the contract.

c. “Business Associate” shall generally have the same meaning as the term “business associate” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean the Contractor.

d. “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean the state agency.

e. “Electronic Protected Health Information” shall mean information that comes within paragraphs (1)(i) or (1)(ii) of the definition of Protected Health Information as specified below.

f. “Enforcement Rule” shall mean the HIPAA Administrative Simplification: Enforcement; Final Rule at 45 CFR Parts 160 and 164.

g. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.

h. “Individual” shall have the same meaning as the term “individual” in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502 (g).

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i. “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E.

j. “Protected Health Information” as defined in 45 CFR 160.103, shall mean individually identifiable health information:

- (i) Except as provided in paragraph (b) of this definition, that is: (i) Transmitted by electronic media; or (ii) Maintained in electronic media; or (iii) Transmitted or maintained in any other form or medium.

- (ii) Protected Health Information excludes individually identifiable health information in (i) Education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g; (ii) Records described at 20 U.S.C. 1232g(a)(4)(B)(iv); and (iii) Employment records held by a covered entity (state agency) in its role as employer.

k. “Security Incident” shall be defined as set forth in the “Obligations of the Contractor” section of the Business Associate Provisions.

l. “Security Rule” shall mean the Security Standards for the Protection of Electronic Protected Health Information at 45 CFR Part 164, Subpart C.

m. “Unsecured Protected Health Information” shall mean Protected Health Information that is not secured through the use of a technology or methodology determined in accordance with 42 U.S.C. § 17932 or as otherwise specified by the secretary of Health and Human Services.

1.1.2 The Contractor agrees and understands that wherever in this document the term Protected Health Information is used, it shall also be deemed to include Electronic Protected Health Information.

1.1.3 The Contractor must appropriately safeguard Protected Health Information which the Contractor receives from or creates or receives on behalf of the state agency. To provide reasonable assurance of appropriate safeguards, the Contractor shall comply with the business associate provisions stated herein, as well as the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH) (PL-111-5) and all regulations promulgated pursuant to authority granted therein.

1.1.4 The state agency and the Contractor agree to amend the contract as is necessary for the parties to comply with the requirements of HIPAA and the Privacy Rule, Security Rule, Enforcement Rule, and other rules as later promulgated (hereinafter referenced as the regulations promulgated thereunder). Any ambiguity in the contract shall be interpreted to permit compliance with the HIPAA Rules.

1.2 Permitted Uses and Disclosures of Protected Health Information by the Contractor:

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RFA #2027 Attachment F

1.2.1 The Contractor may not use or disclose Protected Health Information in any manner that would violate Subpart E of 45 CFR Part 164 if done by the state agency, except for the specific uses and disclosures in the contract.

1.2.2 The Contractor may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, the state agency as specified in the contract, provided that such use or disclosure would not violate HIPAA and the regulations promulgated thereunder.

1.2.3 The Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1) and shall notify the state agency by no later than ten (10) calendar days after the Contractor becomes aware of the disclosure of the Protected Health Information.

1.2.4 If required to properly perform the contract and subject to the terms of the contract, the Contractor may use or disclose Protected Health Information if necessary for the proper management and administration of the Contractor’s business.

1.2.5 If the disclosure is required by law, the Contractor may disclose Protected Health Information to carry out the legal responsibilities of the Contractor.

1.2.6 If applicable, the Contractor may use Protected Health Information to provide Data Aggregation services to the state agency as permitted by 45 CFR 164.504(e)(2)(i)(B).

1.2.7 The Contractor may not use Protected Health Information to de-identify or re-identify the information in accordance with 45 CFR 164.514(a)-(c) without specific written permission from the state agency to do so.

1.2.8 The Contractor agrees to make uses and disclosures and requests for Protected Health Information consistent with the state agency’s minimum necessary policies and procedures.

1.3 Obligations and Activities of the Contractor:

1.3.1 The Contractor shall not use or disclose Protected Health Information other than as permitted or required by the contract or as otherwise required by law, and shall comply with the minimum necessary disclosure requirements set forth in 45 CFR § 164.502(b).

1.3.2 The Contractor shall use appropriate administrative, physical and technical safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by the contract. Such safeguards shall include, but not be limited to:

a. Workforce training on the appropriate uses and disclosures of Protected Health Information pursuant to the terms of the contract;

b. Policies and procedures implemented by the Contractor to prevent inappropriate uses and disclosures of Protected Health Information by its workforce and subcontractors, if applicable;

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RFA #2027 Attachment F

c. Encryption of any portable device used to access or maintain Protected Health Information or use of equivalent safeguard;

d. Encryption of any transmission of electronic communication containing Protected Health Information or use of equivalent safeguard; and

e. Any other safeguards necessary to prevent the inappropriate use or disclosure of Protected Health Information.

1.3.3 With respect to Electronic Protected Health Information, the Contractor shall use appropriate administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the Electronic Protected Health Information that Contractor creates, receives, maintains or transmits on behalf of the state agency and comply with Subpart C of 45 CFR Part 164, to prevent use or disclosure of Protected Health Information other than as provided for by the contract.

1.3.4 In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), the Contractor shall require that any agent or subcontractor that creates, receives, maintains, or transmits Protected Health Information on behalf of the Contractor agrees to the same restrictions, conditions, and requirements that apply to the Contractor with respect to such information.

1.3.5 By no later than ten (10) calendar days after receipt of a written request from the state agency, or as otherwise required by state or federal law or regulation, or by another time as may be agreed upon in writing by the state agency, the Contractor shall make the Contractor’s internal practices, books, and records, including policies and procedures and Protected Health Information, relating to the use and disclosure of Protected Health Information received from, created by, or received by the Contractor on behalf of the state agency available to the state agency and/or to the Secretary of the Department of Health and Human Services or designee for purposes of determining compliance with the HIPAA Rules and the contract.

1.3.6 The Contractor shall document any disclosures and information related to such disclosures of Protected Health Information as would be required for the state agency to respond to a request by an individual for an accounting of disclosures of Protected Health Information in accordance with 42 USCA §17932 and 45 CFR 164.528. By no later than five (5) calendar days of receipt of a written request from the state agency, or as otherwise required by state or federal law or regulation, or by another time as may be agreed upon in writing by the state agency, the Contractor shall provide an accounting of disclosures of Protected Health Information regarding an individual to the state agency. If requested by the state agency or the individual, the Contractor shall provide an accounting of disclosures directly to the individual. The Contractor shall maintain a record of any accounting made directly to an individual at the individual’s request and shall provide such record to the state agency upon request.

1.3.7 In order to meet the requirements under 45 CFR 164.524, regarding an individual’s right of access, the Contractor shall, within five (5) calendar days following a state agency request, or as otherwise required by state or federal law or regulation, or by another time as may be agreed upon in writing by the state agency, provide the state agency access to the Protected Health Information in an individual’s designated record set. However, if requested by the state

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RFA #2027 Attachment F

agency, the Contractor shall provide access to the Protected Health Information in a designated record set directly to the individual for whom such information relates.

1.3.8 At the direction of the state agency, the Contractor shall promptly make any amendment(s) to Protected Health Information in a Designated Record Set pursuant to 45 CFR 164.526.

1.3.9 The Contractor shall report to the state agency’s Security Officer any security incident immediately upon becoming aware of such incident and shall take immediate action to stop the continuation of any such incident. For purposes of this paragraph, security incident shall mean the attempted or successful unauthorized access, use, modification or destruction of information or interference with systems operations in an information system. This does not include trivial incidents that occur on a daily basis, such as scans, “pings,” or unsuccessful attempts that do not penetrate computer networks or servers or result in interference with system operations. By no later than five (5) days after the Contractor becomes aware of such incident, the Contractor shall provide the state agency’s Security Officer with a description of any remedial action taken to mitigate any harmful effect of such incident and a proposed written plan of action for approval that describes plans for preventing any such future security incidents.

1.3.10 The Contractor shall report to the state agency’s Privacy Officer any unauthorized use or disclosure of Protected Health Information not permitted or required as stated herein immediately upon becoming aware of such use or disclosure and shall take immediate action to stop the unauthorized use or disclosure. By no later than five (5) calendar days after the Contractor becomes aware of any such use or disclosure, the Contractor shall provide the state agency’s Privacy Officer with a written description of any remedial action taken to mitigate any harmful effect of such disclosure and a proposed written plan of action for approval that describes plans for preventing any such future unauthorized uses or disclosures.

1.3.11 The Contractor shall report to the state agency’s Security Officer any breach immediately upon becoming aware of such incident and shall take immediate action to stop the continuation of any such incident. By no later than five (5) days after the Contractor becomes aware of such incident, the Contractor shall provide the state agency’s Security Officer with a description of the breach, the information compromised by the breach, and any remedial action taken to mitigate any harmful effect of such incident and a proposed written plan for approval that describes plans for preventing any such future incidents.

1.3.12 The Contractor’s reports required in the preceding paragraphs shall include the following information regarding the security incident, improper disclosure/use, or breach, (hereinafter “incident”):

a. The name, address, and telephone number of each individual whose information was involved if such information is maintained by the Contractor;

b. The electronic address of any individual who has specified a preference of contact by electronic mail;

c. A brief description of what happened, including the date(s) of the incident and the date(s) of the discovery of the incident;

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RFA #2027 Attachment F

d. A description of the types of Protected Health Information involved in the incident (such as full name, Social Security Number, date of birth, home address, account number, or disability code) and whether the incident involved Unsecured Protected Health Information; and

e. The recommended steps individuals should take to protect themselves from potential harm resulting from the incident.

1.3.13 Notwithstanding any provisions of the Terms and Conditions attached hereto, in order to meet the requirements under HIPAA and the regulations promulgated thereunder, the Contractor shall keep and retain adequate, accurate, and complete records of the documentation required under these provisions for a minimum of six (6) years as specified in 45 CFR Part 164.

1.3.14 Contractor shall not directly or indirectly receive remuneration in exchange for any Protected Health Information without a valid authorization.

1.3.15 If the Contractor becomes aware of a pattern of activity or practice of the state agency that constitutes a material breach of contract regarding the state agency's obligations under the Business Associate Provisions of the contract, the Contractor shall notify the state agency’s Security Officer of the activity or practice and work with the state agency to correct the breach of contract.

1.3.16 The Contractor shall indemnify the state agency from any liability resulting from any violation of the Privacy Rule or Security Rule or Breach arising from the conduct or omission of the Contractor or its employee(s), agent(s) or subcontractor(s). The Contractor shall reimburse the state agency for any and all actual and direct costs and/or losses, including those incurred under the civil penalties implemented by legal requirements, including but not limited to HIPAA as amended by the Health Information Technology for Economic and Clinical Health Act, and including reasonable attorney’s fees, which may be imposed upon the state agency under legal requirements, including but not limited to HIPAA’s Administrative Simplification Rules, arising from or in connection with the Contractor’s negligent or wrongful actions or inactions or violations of this Agreement.

1.4 Obligations of the State Agency:

1.4.1 The state agency shall notify the Contractor of limitation(s) that may affect the Contractor’s use or disclosure of Protected Health Information, by providing the Contractor with the state agency’s notice of privacy practices in accordance with 45 CFR 164.520.

1.4.2 The state agency shall notify the Contractor of any changes in, or revocation of, authorization by an Individual to use or disclose Protected Health Information.

1.4.3 The state agency shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the state agency has agreed to in accordance with 45 CFR 164.522.

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RFA #2027 Attachment F

1.4.4 The state agency shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under HIPAA and the regulations promulgated thereunder.

1.5 Expiration/Termination/Cancellation - Except as provided in the subparagraph below, upon the expiration, termination, or cancellation of the contract for any reason, the Contractor shall, at the discretion of the state agency, either return to the state agency or destroy all Protected Health Information received by the Contractor from the state agency, or created or received by the Contractor on behalf of the state agency, and shall not retain any copies of such Protected Health Information. This provision shall also apply to Protected Health Information that is in the possession of subcontractor or agents of the Contractor.

1.5.1 In the event the state agency determines that returning or destroying the Protected Health Information is not feasible, the Contractor shall extend the protections of the contract to the Protected Health Information for as long as the Contractor maintains the Protected Health Information and shall limit the use and disclosure of the Protected Health Information to those purposes that made return or destruction of the information infeasible. If at any time it becomes feasible to return or destroy any such Protected Health Information maintained pursuant to this paragraph, the Contractor must notify the state agency and obtain instructions from the state agency for either the return or destruction of the Protected Health Information.

1.6 Breach of Contract – In the event the Contractor is in breach of contract with regard to the business associate provisions included herein, the Contractor agrees that in addition to the requirements of the contract related to cancellation of contract, if the state agency determines that cancellation of the contract is not feasible, the Department may elect not to cancel the contract, but the state agency shall report the breach of contract to the Secretary of the Department of Health and Human Services.

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RFA #2027EXHIBIT 1

PRICING PAGE ANALYSIS

The Applicant shall provide the cost reimbursement for the original contract period and a maximum price per year for each potential renewal period for providing all services in accordance with the provisions and requirements of the RFA for each area for which they are applying. All costs associated with providing the required services (including, but not limited to, startup, administration, overhead, personnel, support materials, equipment, and supplies) shall be included in the stated price(s). Renewal prices are not guaranteed and will be subject to available funding.

Service Area: Region 1: Counties of Andrew, Atchison, Benton, Buchanan, Caldwell, Carroll, Cass, Chariton, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, and Worth

Year of Contract Track 1 Guaranteed Not-To- Exceed Total Price

Track 2 Guaranteed Not-To-Exceed Total Price

Original Contract Period $_____________(not to exceed $24,250)

$_____________(not to exceed $109,125)

First Renewal Period $_____________(not to exceed $24,250)

$_____________(not to exceed $109,125)

Second Renewal Period $_____________(not to exceed $24,250)

$_____________(not to exceed $109,125)

Service Area: Region 2: Counties of Adair, Audrain, Boone, Callaway, Camden, Clark, Cole, Cooper, Crawford, Franklin, Gasconade, Howard, Knox, Laclede, Lewis, Lincoln, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Phelps, Pike, Pulaski, Putnam, Ralls, Randolph, Schuyler, Scotland, Shelby, St. Charles, Sullivan, and Warren

Year of Contract Track 1 Guaranteed Not-To-Exceed Total Price

Track 2 Guaranteed Not-To-Exceed Total Price

Original Contract Period $_____________

(not to exceed $24,250)

$_____________

(not to exceed $109,125)

First Renewal Period $_____________

(not to exceed $24,250)

$_____________

(not to exceed $109,125)

Second Renewal Period $_____________

(not to exceed $24,250)

$_____________

(not to exceed $109,125)

Page 1 of 3

RFA #2027

Service Area: Region 3: Counties of Barry, Barton, Bates, Cedar, Christian, Dade, Dallas, Douglas, Green Henry, Hickory, Howell, Jasper, Lawrence, McDonald, Newton, Oregon, Ozark, Polk, Shannon, St. Clair, Stone, Taney, Texas, Vernon, Webster, and Wright

Year of Contract Track 1 Guaranteed Not-To-Exceed Total Price

Track 2 Guaranteed Not-To-Exceed Total Price

Original Contract Period $_____________

(not to exceed $24,250)$_____________

(not to exceed $109,125)

First Renewal Period $_____________

(not to exceed $24,250)

$_____________

(not to exceed $109,125)

Second Renewal Period $_____________

(not to exceed $24,250)

$_____________(not to exceed $109,125)

Service Area: Region 4: Counties of Bollinger, Butler, Cape Girardeau, Carter, Dent, Dunklin, Iron, Jefferson, Madison, Mississippi, New Madrid, Pemiscot, Perry, Reynolds, Ripley, Scott, St. Francois, St. Louis City, St. Louis County, Ste. Genevieve, Stoddard, Washington, and Wayne

Year of Contract Track 1 Guaranteed Not-To-Exceed Total Price

Track 2 Guaranteed Not-To-Exceed Total Price

Original Contract Period$_____________

(not to exceed $24,250)$_____________

(not to exceed $109,125)

First Renewal Period $_____________

(not to exceed $24,250)

$_____________

(not to exceed $109,125)

Second Renewal Period $_____________

(not to exceed $24,250)

$_____________(not to exceed $109,125)

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RFA #2027EXHIBIT 1 (CONTINUED)BUDGET/PRICE ANALYSIS

Specify the applicable contract period: Original Contract Period

First Renewal Period

Second Renewal Period

Specify the applicable contract region: Region 1 Region 2 Region 3 Region 4Specify the applicable Track: Track 1 Track 2The Applicant should complete the following table in sufficient detail for information regarding the services proposed. Copy and complete this Budget/Price Analysis Exhibit for each contract period.

Budget Categories Quantity Unit Price TotalProfessional Personnel (list by classification and name, if known)1. $ $2. $ $3. $ $

Total Professional Personnel $Support Personnel (list by classification and name, if known)1. $ $2. $ $3. $ $

Total Support Personnel $Travel Expenses (list)1. $ $2. $ $3. $ $

Total Travel Expenses $Materials and Supplies (list)1. $ $2. $ $3. $ $

Total Materials and Supplies $Contracted Services (List)1. $ $2. $ $3. $ $

Total Contracted Services $Other Direct Expenses1. $ $2. $ $3. $ $

Total Other Direct Expenses $Indirect Costs 10% of the modified direct costTotal Indirect Costs $Guaranteed Not-to-Exceed Total Price (equals Guaranteed Not-to-Exceed Total Price on Pricing Page)

$

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RFA #2027

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RFA #2027EXHIBIT 2

BUSINESS ENTITY CERTIFICATION, ENROLLMENT DOCUMENTATION,AND AFFIDAVIT OF WORK AUTHORIZATION

BUSINESS ENTITY CERTIFICATION:The Applicant must certify their current business status by completing either Box A or Box B or Box C on this Exhibit.

BOX A: To be completed by a non-business entity as defined below.BOX B: To be completed by a business entity who has not yet completed and submitted

documentation pertaining to the federal work authorization program as described at http://www.dhs.gov/files/programs/gc_1185221678150.shtm.

BOX C: To be completed by a business entity who has current work authorization documentation on file with Missouri state agency including Division of Purchasing and Materials Management.

Business entity, as defined in section 285.525, RSMo pertaining to section 285.530, RSMo is any person or group of persons performing or engaging in any activity, enterprise, profession, or occupation for gain, benefit, advantage, or livelihood. The term “business entity” shall include but not be limited to self-employed individuals, partnerships, corporations, Applicants, and subcontractors. The term “business entity” shall include any business entity that possesses a business permit, license, or tax certificate issued by the state, any business entity that is exempt by law from obtaining such a business permit, and any business entity that is operating unlawfully without such a business permit. The term “business entity” shall not include a self-employed individual with no employees or entities utilizing the services of direct sellers as defined in subdivision (17) of subsection 12 of section 288.034, RSMo.

Note: Regarding governmental entities, business entity includes Missouri schools, Missouri universities (other than stated in Box C), out of state agencies, out of state schools, out of state universities, and political subdivisions. A business entity does not include Missouri state agencies and federal government entities.

BOX A – CURRENTLY NOT A BUSINESS ENTITY

Page 1 of 4

I certify that _____________________ (Company/Individual Name) DOES NOT CURRENTLY MEET the definition of a business entity, as defined in section 285.525, RSMo pertaining to section 285.530, RSMo as stated above, because: (check the applicable business status that applies below)

I am a self-employed individual with no employees; OR The company that I represent employs the services of direct sellers as defined in subdivision

(17) of subsection 12 of section 288.034, RSMo.

I certify that I am not an alien unlawfully present in the United States and if _____________________ (Company/Individual Name) is awarded a contract for the services requested herein under RFA #2027 (Application Number) and if the business status changes during the life of the contract to become a business entity as defined in section 285.525, RSMo pertaining to section 285.530, RSMo then, prior to the performance of any services as a business entity, _____________________ (Company/Individual Name) agrees to complete Box B, comply with the requirements stated in Box B and provide the Missouri Department of Health & Senior Services with all documentation required in Box B of this exhibit.

_____________________________ _____________________________Authorized Representative’s Name Authorized Representative’s Signature

(Please Print)

_____________________________ _____________________________Company Name (if applicable) Date

RFA #2027EXHIBIT 2, continued

BOX B – CURRENT BUSINESS ENTITY STATUS

Page 2 of 4

I certify that _____________________ (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525, RSMo pertaining to section 285.530.

_____________________________ _____________________________Authorized Business Entity Representative’s Name

Authorized Business Entity Representative’s Signature

(Please Print)

_____________________________ _____________________________Business Entity Name Date

_____________________________E-Mail Address

As a business entity, the Applicant/Contractor must perform/provide each of the following. The Applicant/Contractor should check each to verify completion/submission of all of the following:

Enroll and participate in the E-Verify federal work authorization program (Website: http://www.dhs.gov/files/programs/gc_1185221678150.shtm; Phone: 888-464-4218; Email: e-verify@dhs.gov) with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services required herein; AND

Provide documentation affirming said company’s/individual’s enrollment and participation in the E-Verify federal work authorization program. Documentation shall include EITHER the E-Verify Employment Eligibility Verification page listing the Applicant’s/Contractor’s name and company ID OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Applicant’s/Contractor’s name and the MOU signature page completed and signed, at minimum, by the Applicant/Contractor and the Department of Homeland Security – Verification Division. If the signature page of the MOU lists the Applicant’s/Contractor’s name and company ID, then no additional pages of the MOU must be submitted.; AND

Submit a completed, notarized Affidavit of Work Authorization provided on the next page of this Exhibit.

RFA #2027EXHIBIT 2, continued

AFFIDAVIT OF WORK AUTHORIZATION:

The Applicant who meets the section 285.525, RSMo definition of a business entity must complete and return the following Affidavit of Work Authorization.

Comes now _______________________ (Name of Business Entity Authorized Representative) as ____________________ (Position/Title) first being duly sworn on my oath, affirm ________________________ (Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that ______________________ (Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services provided to the contract(s) for the duration of the contract(s), if awarded.

In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.)

Authorized Representative’s Signature Printed Name

Title Date

E-Mail Address E-Verify Company ID Number

Subscribed and sworn to before me this _____________ of ___________________. I am (DAY) (MONTH, YEAR)

commissioned as a notary public within the County of ________________, State of (NAME OF COUNTY)

_______________________, and my commission expires on _________________.(NAME OF STATE) (DATE)

Signature of Notary Date

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RFA #2027EXHIBIT 2, continued

(Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the Department. If completing Box C, do not complete Box B.)

BOX C – AFFIDAVIT ON FILE - CURRENT BUSINESS ENTITY STATUS

I certify that ______________________ (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, and have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following.

The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the Applicant’s name and the MOU signature page completed and signed by the Applicant and the Department of Homeland Security – Verification Division

A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized within the past twelve months).

Name of Missouri State Agency or Public University* to Which Previous E-Verify Documentation Submitted: _____________________________________________________________________

(*Public University includes the following five schools under chapter 34, RSMo: Harris-Stowe State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Joseph; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau.)

Date of Previous E-Verify Documentation Submission: ______________________

Previous Application/Contract Number for Which Previous E-Verify Documentation Submitted: ___________________(if known)

Authorized Business Entity Representative’s Name (Please Print)

Authorized Business EntityRepresentative’s Signature

E-Verify MOU Company ID Number E-Mail Address

Business Entity Name Date

FOR STATE USE ONLY

Documentation Verification Completed By:

Procurement Officer Date

Page 4 of 4

RFA #2027 EXHIBIT 3

I. Please Print or TypeLegal Business Name:

Doing Business As:

Street Address: (Must be the physical location. No P.O. boxes please)

City: State:

Zip Code+4: (see http://zip4.usps.com/zip4/welcome.jsp)

Congressional District: (see http://ziplook.house.gov/htbin/findrep?ZIP=)

Contact Person: Email:

Telephone Number: Extension: Federal Tax ID Number:

DUNS Number:

A DUNS number is FREE for any business required to register with the U.S. government to receive federal contracts or grants.

To register for your DUNS number, go to http://fedgov.dnb.com/webform or call 1-866-705-5711.

If you are acting in your individual capacity unrelated to any business or non-profit organization, a DUNS number may not be required, see Section III on page 4.

Parent DUNS Number:(if applicable)

Executive CompensationTo determine whether you are required to report executive compensation data, please answer the following questions:

1. In your business or organization’s previously completed fiscal year, did your business or organization receive $25,000,000 or more in annual gross revenues from government grant money?

YES NO (If the answer is No skip questions 2 and 3 because you do not need to report your organization’s executive compensation data (Section II on page 3). Sign

Page 1 of 4MO 580-3097(04-16)

Missouri Department of Health and Senior ServicesFederal Funding Accountability and Transparency Act (FFATA) Contractor/Subawardee Data Form P.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6024 FAX: 573-526-0430

RFA #2027 EXHIBIT 3

certification below and return the form. You do not need to complete Sections II and III of the form.)

2. In your business or organization’s previously completed fiscal year, did your business or organization receive 80 percent or more of its annual gross revenues from government grant money?

YES NO (If the answer is No skip question 3 because you do not need to report your organization’s executive compensation data (Section II on page 3). Sign certification below and return the form. You do not need to complete Sections II and III of the form.)

3. Does the public have access to information on the compensation of the senior executives?

YES NO (If the answer is No, you are required to report the names and total compensation of the five highest compensated officers/executives in your organization for the previous fiscal year. Complete Section II – Executive Compensation Reporting on page 3, sign certification below and return the form. You do not need to complete Section III of the form.

If the answer is Yes, sign certification below and return the form. You do not need to complete Sections II and III of the form.)

Use the following to help determine if the public has access to the compensation of the senior executives.

1) Reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) OR Title 26 U.S. Chapter 21 Code § 6104 - Publicity Of Information Required From Certain Exempt Organizations And Certain Trusts; or

2) The company's annual proxy statement; or

3) The company's annual report on Form 10-K; or

4) Registration statements filed by the company to register securities for sale to the public.

See the U.S. Security and Exchange Commission’s Executive Compensation website at: http://www.sec.gov/answers/execomp.htm additional information.

CertificationI certify the facts stated herein are true and correct. I understand the information provided will be reported by the Department of Health and Senior Services to the FFATA Subaward Reporting System (FSRS) and that the information will be accessible to the public at USASpending.gov.

Authorized Representative’s Signature Printed Name

Title Date

Page 2 of 4MO 580-3097(04-16)

Missouri Department of Health and Senior ServicesFederal Funding Accountability and Transparency Act (FFATA) Contractor/Subawardee Data Form P.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6024 FAX: 573-526-0430

RFA #2027 EXHIBIT 3

Executive Compensation ReportingDefinitions:

1. Executive: means officers, managing partners, or any other employees in management positions.

2. Total compensation: means the cash and noncash dollar value earned by the executive during the recipient’s or subrecipient’s preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):

a. Salary and bonus.

b. Awards of stock, stock options, and stock appreciation rights. Use the dollar amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with the Statement of Financial Accounting Standards No. 123 (Revised 2004) (FAS 123R), Shared Based Payments.

c. Earnings for services under non-equity incentive plans. This does not include group life, health, hospitalization or medical reimbursement plans that do not discriminate in favor of executives, and are available generally to all salaried employees.

d. Change in pension value. This is the change in present value of defined benefit and actuarial pension plans.

e. Above-market earnings on deferred compensation which is not tax-qualified.

f. Other compensation, if the aggregate value of all such other compensation (e.g. severance, termination payments, value of life insurance paid on behalf of the employee, perquisites or property) for the executive exceeds $10,000.

Names and Compensation of Highly Compensated Officials1

Name Amount

2

Name Amount

3

Name Amount

4

Name Amount

5

Name Amount

Page 3 of 4MO 580-3097(04-16)

Missouri Department of Health and Senior ServicesFederal Funding Accountability and Transparency Act (FFATA) Contractor/Subawardee Data Form P.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6024 FAX: 573-526-0430

RFA #2027 EXHIBIT 3

II. For Contractor/Subawardee attesting exemption

I attest that I am not required to obtain a DUNS number because I am acting as a contractor/ subawardee in my individual capacity completely unrelated to any business or non-profit organization, including any that I own or operate in my name (2 CFR 25.110(b)).

Authorized Representative’s Signature Printed Name

Title Date

Page 4 of 4MO 580-3097(04-16)

Missouri Department of Health and Senior ServicesFederal Funding Accountability and Transparency Act (FFATA) Contractor/Subawardee Data Form P.O. Box 570, Jefferson City, MO 65102-0570 Phone: 573-751-6024 FAX: 573-526-0430

RFA #2027 EXHIBIT 4

APPLICANT INFORMATION

The Applicant should provide the following information about the Applicant’s organization:

a. Provide the applicant’s work history, including the founding date and number of years in business as currently constituted.

b. Describe the nature of the Applicant’s business, all services performed, etc. Identify the Applicant’s website address, if any.

c. Provide a list of and a short summary of information regarding the Applicant’s current contracts/clients.

d. List, identify, and provide reasons for each contract lost in the past 5 years.

e. If the contractor has had a previous contract with the State of Missouri, provide a copy of monitoring findings. In addition, if the applicant or any of its proposed subgrantees or contractors have received letters designating their organization as high risk, provide copies along with Corrective Action Plans (CAPs) and notices of resolution.

f. Describe the structure of the organization including any board of directors, partners, top departmental management, corporate organization, corporate trade affiliations, any parent/subsidiary affiliations with other firms, etc.

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RFA #2027 EXHIBIT_5

CURRENT/PRIOR EXPERIENCE

The Applicant should copy and complete this form documenting the Applicant and subcontractor’s current/prior experience considered relevant to the services required herein. In addition, the Applicant is advised that if the contact person listed for verification of services is unable to be reached during the evaluation, the listed experience may not be considered.

Applicant Name or Subcontractor Name: ____________________________________________________

Reference Information (Current/Prior Services Performed For:)

Name of Reference Company:Address of Reference Company Street Address City, State, Zip

Reference Contact Person Information: Name Phone # E-mail Address

Dates of Services:

If service/contract has terminated, specify reason:

Dollar Value of Services

Description of Services Performed

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RFA #2027 EXHIBIT_6

EXPERTISE OF KEY PERSONNEL(Copy and complete this table for each key person proposed)

Title of Position:______________________________

Name of Person:

Educational Degree (s): include college or university, major, and datesLicense(s)/Certification(s), #(s), expiration date(s), if applicable:

Specialized Training Completed. Include dates and documentation of completion:

# of years experience in area of service proposed to provide:

Describe person’s relationship to Applicant. If employee, # of years. If subcontractor, describe other/past working relationships

Describe this person’s responsibilities over the past 12 months.

Previous employer(s), positions, and dates

Identify specific information about experience in:

Clearly identify the experience, provide dates, describe the person’s role and extent of involvement in the experience

Alzheimer’s and Dementia Caregiver training Care Coordination Respite fund administration

Staffing MethodologyDescribe the person’s planned duties/role proposed herein:

Specify the approximate number of hours per month this person is proposed for services

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RFA #2027 EXHIBIT 7

EXPERTISE OF PERSONNEL

Personnel Background and Expertise of Personnel and

Planned Duties

1. ________________________________(Name)________________________________(Title)________________________________(Proposed Role/Function)

2. ________________________________(Name)________________________________(Title) ________________________________(Proposed Role/Function)

3. ________________________________(Name)________________________________(Title) ________________________________(Proposed Role/Function)

4. ________________________________(Name)________________________________(Title) ________________________________(Proposed Role/Function)

5. ________________________________(Name)________________________________(Title) ________________________________(Proposed Role/Function)

6. ________________________________(Name)________________________________(Title) ________________________________(Proposed Role/Function)

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RFA #2027 EXHIBIT 8

MISCELLANEOUS INFORMATION

If any products and/or services offered under this RFA are being manufactured or performed at sites outside the United States, the Applicant MUST disclose such fact and provide details in the space below or on an attached page.

Are any of the Applicant’s proposed products and/or services being manufactured or performed at sites outside the United States?

Yes ____ No ____

If YES, do the proposed products/services satisfy the conditions described in section 4 1., 2., 3., or 4. of Executive Order 04-09? (see the  following web link: http://www.sos.mo.gov/library/reference/orders/2004/eo04_009.asp)

Yes ____ No ____

If YES, mark the appropriate exemption below, and provide the requested details:____ 1. Unique good or service. 

EXPLAIN:_________________________________________________________________ 2. Foreign firm hired to market Missouri services/products to a foreign country.

Identify foreign country: _______________________________________ 3. Economic cost factor exists

EXPLAIN:________________________________________________________________ 4. Applicant/subcontractor maintains significant business presence in the United States and only

performs trivial portion of contract work outside US.  Identify maximum percentage of the overall value of the contract, for any contract period,

attributed to the value of the products and/or services being manufactured or performed at sites outside the United States: ___%

Specify what contract work would be performed outside the United States: ________________________________________________________________

Employee Application/Conflict of Interest:

Applicants who are elected or appointed officials or employees of the State of Missouri or any political subdivision thereof, serving in an executive or administrative capacity, must comply with sections 105.450 to 105.458, RSMo, regarding conflict of interest. If the Applicant or any owner of the Applicant’s organization is currently an elected or appointed official or an employee of the State of Missouri or any political subdivision thereof, please provide the following information:

Name and title of elected or appointed official or employee of the State of Missouri or any political subdivision thereof:If employee of the State of Missouri or political subdivision thereof, provide name of Department or political subdivision where employed:Percentage of ownership interest in Applicant’s organization held by elected or appointed official or employee of the State of Missouri or political subdivision thereof:

__________%

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RFA #2027 EXHIBIT 8, continued

MISCELLANEOUS INFORMATION

Registration of Business Name (if applicable) with the Missouri Secretary of StateThe Applicant should indicate the Applicant’s charter number and company name with the Missouri Secretary of State.  Additionally, the Applicant should provide proof of the Applicant’s good standing status with the Missouri Secretary of State. If the Applicant is exempt from registering with the Missouri Secretary of State pursuant to section 351.572, RSMo., identify the specific section of 351.572 RSMo., which supports the exemption. 

Charter Number (if applicable) Company NameIf exempt from registering with the Missouri Secretary of State pursuant to section 351.572 RSMo., identify the section of 351.572 to support the exemption:

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RFA #2027 EXHIBIT 9

METHOD OF PERFORMANCE

The Applicant should present a written plan for performing the requirements specified in this RFA. In presenting such information, the Applicant should specifically address each of the following issues:

1. In presenting the method of performance, the Applicant should submit or describe the following:

a. Identify and describe a plan to seek and enroll participants for each service area in which you are applying to provide services. Using Attachment C, explain how you plan to expand services to included counties that do not show any participation for PY19. Include how qualified participants will be determined.

b. Describe your Track 1 and Track 2 programs in detail to include how each program will look, copies of the intake forms, training materials/guides, and program participant survey that will be used. If utilizing an online training system please provide a description of the program, screen shot examples of the material, and explain how participants (especially those with limited or no internet access) will be able to access the training system. If a third party resource for training will be used, provide data showing the efficacy of the program.

c. Describe your outreach activities for each service area in which you are applying to serve. Provide copies of materials produced for advertising your services, if applicable.

d. Describe your partnerships with the Missouri Chapter of the Alzheimer’s Association, Area Agencies on Aging, and other community service providers that target the older adult population in the service area(s) you are applying for (with emphasis on minority, low income or rural areas).

e. Describe the method for collecting information to prevent duplication of services between Track 1 and Track 2, to ensure multiple family members do not request respite funds for the same participant and to certify that the funds are used as a payor of last resort.

f. Describe the referral opportunities you have identified in each service area for which you are applying to provide services.

g. Provide at least three letters of support for the proposed program. Such letters of support should come from agencies or organizations with which the applicant intends to collaborate.

2. Organizational Chart - The Applicant should provide an organizational chart showing the staffing and lines of authority for the key personnel to be used. The organizational chart should include (1) The relationship of service personnel to management and support personnel, (2) The names of the personnel and the working titles of each, and (3) Any proposed subcontractors including management, supervisory, and other key personnel.

a. The organizational chart should outline the team proposed for this project and the relationship of those team members to each other and to the management structure of the Applicant’s organization.

Page 1 of 2

RFA #2027

3. Along with a detailed organizational chart, the Applicant should describe the following:

a. How services of the contract will be managed, controlled, and supervised in order to ensure satisfactory contract performance.

b. Total Personnel Resources - The Applicant should provide information that documents the depth of resources to ensure completion of all requirements on time and on target. If the Applicant has other ongoing contracts that also require personnel resources, the Applicant should document how sufficient resources will be provided to the Department.

4. Economic Impact to Missouri - the Applicant should describe the economic advantages that will be realized as a result of the Applicant performing the required services. The Applicant should respond to the following:

a. Provide a description of the proposed services that will be performed and/or the proposed products that will be provided by Missourians and/or Missouri products.

b. Provide a description of the economic impact returned to the State of Missouri through tax revenue obligations.

c. Provide a description of the company’s economic presence within the State of Missouri (e.g., type of facilities: sales offices; sales outlets; divisions; manufacturing; warehouse; other), including Missouri employee statistics.

Page 2 of 2

RFA #2027

EXHIBIT 10PARTICIPATION COMMITMENT

Organization for the Blind/Sheltered Workshop and/or Service-Disabled Veteran Business Enterprise (SDVE) Participation Commitment – If the Applicant is committing to participation by or if the Applicant is a qualified organization for the blind/sheltered workshop and/or a qualified SDVE, the Applicant must provide the required information in the appropriate table(s) below for the organization proposed and must submit the completed exhibit with the Applicant’s bid.

Organization for the Blind/Sheltered Workshop Commitment Table The services performed or the products provided by the listed Organization for the Blind/Sheltered

Workshop must provide a commercially useful function related to the delivery of the contractually-required service/product in a manner that will constitute an added value to the contract and shall be performed/provided exclusive to the performance of the contract.

The Applicant must either be an organization for the blind or sheltered workshop or must be proposing to utilize an organization for the blind/sheltered workshop as a subcontractor and/or supplier in an amount that must equal, at a minimum, the greater of $5,000 or 2% of the total dollar value of the contract for purchases not exceeding $10 million.

The Applicant may propose more than one organization for the blind/sheltered workshop as part of the Applicant’s total committed participation. However, the services performed or products provided must still meet the requirements noted herein.

Name of Organization for the Blind or Sheltered Workshop

Proposed

Committed Participation($ amount or

% of total value of contract)

Description of Products/Services to be Provided by Listed Organization for the

Blind/Sheltered WorkshopThe Applicant should also include the paragraph

number(s) from the RFA which requires the product/service the organization for the

blind/sheltered workshop is proposed to perform and describe how the proposed product/service constitutes added value and will be exclusive to

the contract.1.

%Product/Service(s) proposed:

RFA Paragraph References:2.

%Product/Service(s) proposed:

RFA Paragraph References:Total Blind/Sheltered Workshop Percentage: %

Page 1 of 2

RFA #2027

EXHIBIT 10, (continued)PARTICIPATION COMMITMENT

SDVE Participation Commitment Table(The services performed or the products provided by the listed SDVE must provide a commercially useful function related to the delivery of the contractually-required service/product in a manner that will constitute an added value to the contract and

shall be performed/provided exclusive to the performance of the contract.)

Name of Each Qualified Service-Disabled Veteran

Business Enterprise (SDVE) Proposed

Committed Percentage of Participation

for Each SDVE

(% of the Actual Total Contract

Value)

Description of Products/Services to be Provided by Listed SDVE

The Applicant should also include the paragraph number(s) from the RFA which requires the

product/service the SDVE is proposed to perform and describe how the proposed product/service constitutes added value and will be exclusive to

the contract.

1.%

Product/Service(s) proposed:

RFA Paragraph References:

2.%

Product/Service(s) proposed:

RFA Paragraph References:

Total SDVE Percentage: %

Page 2 of 2

RFA #2027

EXHIBIT 11

DOCUMENTATION OF INTENT TO PARTICIPATEIf the Applicant is proposing to include the participation of an Organization for the Blind/Sheltered Workshop and/or qualified Service-Disabled Veteran Business Enterprise (SDVE) in the provision of the products/services required in the RFA, the Applicant must either provide this Exhibit or letter of intent, recently signed by each organization documenting the following information with the Applicant’s bid.

~ Copy This Form For Each Organization Proposed ~

Applicant Name:

This Section To Be Completed by Participating Organization:

By completing and signing this form, the undersigned hereby confirms the intent of the named participating organization to provide the products/services identified herein for the Applicant identified above.

Indicate appropriate business classification(s):Organization for the Blind

Sheltered Workshop SDVE

Name of Organization:(Name of Organization for the Blind or Sheltered Workshop or SDVE)

Contact Name: Email:Address (If SDVE, provide MO Address):

Phone #:

City: Fax #:State/Zip: Certification #SDVE’s WebsiteAddress:

Certification Expiration Date:

(or attach copy of certification)

Service-Disabled Veteran’s (SDV) Name:

SDV’s Signature:

(Please Print)

PRODUCTS/SERVICES PARTICIPATING ORGANIZATION AGREED TO PROVIDE

Describe the products/services you (as the participating organization) have agreed to provide:

Authorized Signature:

Authorized Signature of Participating Organization(Organization for the Blind Sheltered Workshop or SDVE)

Date

Page 1 of 2

RFA #2027EXHIBIT 11 (continued)

DOCUMENTATION OF INTENT TO PARTICIPATE

SERVICE-DISABLED VETERAN BUSINESS ENTERPRISE (SDVE)

If a participating organization is an SDVE, unless the Service-Disabled Veteran’s (SDV) documents were previously submitted within the past three (3) years to the state agency or to the Office of Administration, Division of Purchasing, the Applicant must provide the following SDV documents:

a copy of the SDV’s Certificate of Release or Discharge from Active Duty (DD Form 214), and a copy of the SDV’s disability rating letter issued by the Department of Veterans Affairs establishing a service connected disability rating, or a Department of Defense determination of service connected disability.

(NOTE: The SDV’s Certificate of Release or Discharge from Active Duty (DD Form 214), and the SDV’s disability rating letter issued by the Department of Veterans Affairs establishing a service connected disability rating, or Department of Defense determination of service connected disability shall be considered confidential pursuant to subsection 14 of section 610.021, RSMo.)

The Applicant should check the appropriate statement below and, if applicable, provide the requested information.

No, I have not previously submitted the SDV documents specified above to the state agency or to the Office of Administration, Division of Purchasing and therefore have enclosed the SDV documents.

Yes, I previously submitted the SDV documents specified above within the past three (3) years to the state agency.

Yes, I previously submitted the SDV documents specified above within the past three (3) years to the Office of Administration, Division of Purchasing.

Date SDV Documents were Submitted: ______________________

Previous Application/Contract Number for Which the SDV Documents were Submitted: ___________(if known)

(NOTE: If the SDVE and SDV are listed on the Division of Purchasing’s SDVE database located at http://oa.mo.gov/sites/default/files/sdvelisting.pdf , then the SDV documents have been submitted to the Division of Purchasing within the past three [3] years. However, if it has been determined that an SDVE at any time no longer meets the requirements stated above, the Division of Purchasing will remove the SDVE and associated SDV from the database.)

FOR STATE USE ONLY

SDV Documents - Verification Completed By:

Procurement Officer Date

Page 2 of 2

RFA #2027STATE OF MISSOURI

DEPARTMENT OF HEALTH AND SENIOR SERVICES

TERMS AND CONDITIONSThis contract expresses the complete agreement of the parties and performance shall be governed solely by the specifications and requirements contained herein. Any change must be accomplished by a formal signed amendment prior to the effective date of such change.

1. APPLICABLE LAWS AND REGULATIONSa. The contract shall be construed according to the laws of the State of Missouri (state). The contractor shall comply with all local, state, and federal laws and

regulations related to the performance of the contract to the extent that the same may be applicable.b. To the extent that a provision of the contract is contrary to the Constitution or laws of the State of Missouri or of the United States, the provisions shall be void and

unenforceable. However, the balance of the contract shall remain in force between the parties unless terminated by consent of both the contractor and the state.c. The contractor must be registered and maintain good standing with the Secretary of State of the State of Missouri and other regulatory agencies, as may be required

by law or regulations.d. The contractor must timely file and pay all Missouri sales, withholding, corporate and any other required Missouri tax returns and taxes, including interest and

additions to tax.e. The exclusive venue for any legal proceeding relating to or arising out of the contract shall be in the Circuit Court of Cole County, Missouri.f. The contractor shall only employ personnel authorized to work in the United States in accordance with applicable federal and state laws and Executive Order 07-13

for work performed in the United States.

2. INVOICING AND PAYMENTa. The State of Missouri does not pay state or federal taxes unless otherwise required under law or regulation. Prices shall include all packing, handling and shipping

charges FOB destination, freight prepaid and allowed unless otherwise specified herein.b. The statewide financial management system has been designed to capture certain receipt and payment information. For each purchase order received, an invoice

must be submitted that references the purchase order number and must be itemized in accordance with items listed on the purchase order. Failure to comply with this requirement may delay processing of invoices for payment.

c. The contractor shall not transfer any interest in the contract, whether by assignment or otherwise, without the prior written consent of the state.d. Payment for all equipment, supplies, and/or services required herein shall be made in arrears unless otherwise indicated in the specific contract terms.e. The State of Missouri assumes no obligation for equipment, supplies, and/or services shipped or provided in excess of the quantity ordered. Any unauthorized

quantity is subject to the state's rejection and shall be returned at the contractor's expense.f. All invoices for equipment, supplies, and/or services purchased by the State of Missouri shall be subject to late payment charges as provided in section 34.055,

RSMo.g. The State of Missouri reserves the right to purchase goods and services using the state purchasing card.

3. DELIVERY Time is of the essence. Deliveries of equipment, supplies, and/or services must be made no later than the time stated in the contract or within a reasonable period of time, if a specific time is not stated.

4. INSPECTION AND ACCEPTANCEa. No equipment, supplies, and/or services received by an agency of the state pursuant to a contract shall be deemed accepted until the agency has had reasonable

opportunity to inspect said equipment, supplies, and/or services.b. All equipment, supplies, and/or services which do not comply with the specifications and/or requirements or which are otherwise unacceptable or defective may be

rejected. In addition, all equipment, supplies, and/or services which are discovered to be defective or which do not conform to any warranty of the contractor upon inspection (or at any later time if the defects contained were not reasonably ascertainable upon the initial inspection) may be rejected.

c. The State of Missouri reserves the right to return any such rejected shipment at the contractor's expense for full credit or replacement and to specify a reasonable date by which replacements must be received.

d. The State of Missouri's right to reject any unacceptable equipment, supplies, and/or services shall not exclude any other legal, equitable or contractual remedies the state may have.

5. CONFLICT OF INTEREST

Elected or appointed officials or employees of the State of Missouri or any political subdivision thereof, serving in an executive or administrative capacity, must comply with sections 105.452 and 105.454, RSMo, regarding conflict of interest.

6. WARRANTY The contractor expressly warrants that all equipment, supplies, and/or services provided shall: (1) conform to each and every specification, drawing, sample or other description which was furnished to or adopted by the state, (2) be fit and sufficient for the purpose intended, (3) be merchantable, (4) be of good materials and workmanship, and (5) be free from defect. Such warranty shall survive delivery and shall not be deemed waived either by reason of the state's acceptance of or payment for said equipment, supplies, and/or services.

Page 1 of 2Revised 01/26/12

RFA #20277. REMEDIES AND RIGHTSa. No provision in the contract shall be construed, expressly or implied, as a waiver by the State of Missouri of any existing or future right and/or remedy available by

law in the event of any claim by the State of Missouri of the contractor's default or breach of contract.b. The contractor agrees and understands that the contract shall constitute an assignment by the contractor to the State of Missouri of all rights, title and interest in and

to all causes of action that the contractor may have under the antitrust laws of the United States or the State of Missouri for which causes of action have accrued or will accrue as the result of or in relation to the particular equipment, supplies, and/or services purchased or procured by the contractor in the fulfillment of the contract with the State of Missouri.

8. CANCELLATION OF CONTRACTa. In the event of material breach of the contractual obligations by the contractor, the state may cancel the contract. At its sole discretion, the state may give the

contractor an opportunity to cure the breach or to explain how the breach will be cured. The actual cure must be completed within no more than 10 working days from notification, or at a minimum the contractor must provide the state within 10 working days from notification a written plan detailing how the contractor intends to cure the breach.

b. If the contractor fails to cure the breach or if circumstances demand immediate action, the state will issue a notice of cancellation terminating the contract immediately. If it is determined the state improperly cancelled the contract, such cancellation shall be deemed a termination for convenience in accordance with the contract.

c. If the state cancels the contract for breach, the state reserves the right to obtain the equipment, supplies, and/or services to be provided pursuant to the contract from other sources and upon such terms and in such manner as the state deems appropriate and charge the contractor for any additional costs incurred thereby.

d. The contractor understands and agrees that funds required to fund the contract must be appropriated by the General Assembly of the State of Missouri for each fiscal year included within the contract period. The contract shall not be binding upon the state for any period in which funds have not been appropriated, and the state shall not be liable for any costs associated with termination caused by lack of appropriations.

9. BANKRUPTCY OR INSOLVENCY Upon filing for any bankruptcy or insolvency proceeding by or against the contractor, whether voluntary or involuntary, or upon the appointment of a receiver, trustee, or assignee for the benefit of creditors, the contractor must notify the state immediately. Upon learning of any such actions, the state reserves the right, at its sole discretion, to either cancel the contract or affirm the contract and hold the contractor responsible for damages.

10. INVENTIONS, PATENTS AND COPYRIGHTS The contractor shall defend, protect, and hold harmless the State of Missouri, its officers, agents, and employees against all suits of law or in equity resulting from patent and copyright infringement concerning the contractor's performance or products produced under the terms of the contract.

11. NON-DISCRIMINATION AND AFFIRMATIVE ACTION In connection with the furnishing of equipment, supplies, and/or services under the contract, the contractor and all subcontractors shall agree not to discriminate against recipients of services or employees or Applicants for employment on the basis of race, color, religion, national origin, sex, age, disability, or veteran status unless otherwise provided by law. If the contractor or subcontractor employs at least 50 persons, they shall have and maintain an affirmative action program which shall include:

a. A written policy statement committing the organization to affirmative action and assigning management responsibilities and procedures for evaluation and dissemination;

b. The identification of a person designated to handle affirmative action;c. The establishment of non-discriminatory selection standards, objective measures to analyze recruitment, an upward mobility system, a wage and salary structure,

and standards applicable to layoff, recall, discharge, demotion, and discipline;d. The exclusion of discrimination from all collective bargaining agreements; ande. Performance of an internal audit of the reporting system to monitor execution and to provide for future planning.

If discrimination by a contractor is found to exist, the state shall take appropriate enforcement action which may include, but not necessarily be limited to, cancellation of the contract, suspension, or debarment by the state until corrective action by the contractor is made and ensured, and referral to the Attorney General's Office, whichever enforcement action may be deemed most appropriate.

12. AMERICANS WITH DISABILITIES ACT In connection with the furnishing of equipment, supplies, and/or services under the contract, the contractor and all subcontractors shall comply with all applicable requirements and provisions of the Americans with Disabilities Act (ADA).

13. FILING AND PAYMENT OF TAXESThe commissioner of administration and other agencies to which the state purchasing law applies shall not contract for goods or services with a vendor if the vendor or an affiliate of the vendor makes sales at retail of tangible personal property or for the purpose of storage, use, or consumption in this state but fails to collect and properly pay the tax as provided in chapter 144, RSMo. For the purposes of this section, "affiliate of the vendor" shall mean any person or entity that is controlled by or is under common control with the vendor, whether through stock ownership or otherwise.

14. COMMUNICATIONS AND NOTICESAny notice to the contractor shall be deemed sufficient when deposited in the United States mail postage prepaid, transmitted by facsimile, transmitted by e-mail or hand-carried and presented to an authorized employee of the contractor.

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